Psychogenic nonepileptic seizure: An empathetic, practical approach

Psychogenic nonepileptic seizure (PNES) is often misdiagnosed as epilepsy, leading to unnecessary treatments and procedures, as well as failure to engage patients in needed mental health care. To establish an accurate diagnosis, video electroencephalography (EEG) in the context of and simultaneous with a comprehensive neurologic and psychosocial evaluation is recommended for any patient with seizures that are not responding to treatment. Delivering the diagnosis with empathy and respect is a crucial component of care that helps patients establish trust with caregivers and follow treatment recommendations. Effective treatment is available, highlighting the importance of early diagnosis to avoid unnecessary and potentially harmful treatment. But there are many barriers to care, including provider misperceptions, lack of acceptance of the diagnosis, poor patient engagement with treatment, and lack of access to care.