First do no harm: Preventing harm and optimizing care in psychogenic nonepileptic seizures

Area of Science:

• Neurology
• Psychiatry
• Neuroscience

Background:

• Psychogenic nonepileptic seizures (PNES) present with symptoms mimicking epileptic seizures (ES) but lack electrographic ictal discharges.
• PNES are presumed to have neuropsychiatric-neurobehavioral origins.

Purpose of the Study:

• To highlight the diagnostic challenges of PNES.
• To emphasize the importance of timely diagnosis and psychiatric referral for effective patient management.

Main Methods:

• Diagnosis confirmation via video-electroencephalogram (v-EEG).
• Absence of ictal EEG changes and presence of normal awake EEG rhythms during events are key indicators.
• Clinical suspicion in relevant settings is vital.

Main Results:

• Obstacles to timely diagnosis and psychiatric referral are common.
• Delayed diagnosis can lead to unnecessary treatments and significant healthcare system burden.

Conclusions:

• Accurate PNES diagnosis is critical and best achieved with v-EEG.
• Interdisciplinary collaboration, therapeutic alliance, and realistic goals are essential for effective long-term care led by psychiatric and neurologic providers.