Difference between revisions of "Psychogenic nonepileptic seizure"

(Management)
(Background)
Line 1: Line 1:
 
==Background==
 
==Background==
 
+
*Psychogenic nonepileptic seizure (PNES) characterized disturbances of motor, sensory, autonomic, cognitive, and/or emotional functions that can mimic epileptic seizures.
 +
*In contrast to epileptic seizures, PNES are not associated with abnormally excessive neuronal activity but are instead derived from psychologic causes.
 +
*The term pseudoseizures and hysterical seizures are historical terms that are now discouraged.
 +
*Accurate diagnosis is best achieved via a detailed history, physical examination, selected testing, and neurology and/or psychiatry evaluation.
 +
*Epidemiology
 +
**Estimated incidence rate ranges from 1.5 to 5 per 100,000 persons per year.
 +
**Estimate prevalence 2 to 33 per 100,000 persons.
 +
*Etiology
 +
**Dissociative disorders and conversion disorders are felt to be the underlying cause to most episodes of PNES.
  
 
==Clinical Features==
 
==Clinical Features==

Revision as of 03:17, 5 June 2018

Background

  • Psychogenic nonepileptic seizure (PNES) characterized disturbances of motor, sensory, autonomic, cognitive, and/or emotional functions that can mimic epileptic seizures.
  • In contrast to epileptic seizures, PNES are not associated with abnormally excessive neuronal activity but are instead derived from psychologic causes.
  • The term pseudoseizures and hysterical seizures are historical terms that are now discouraged.
  • Accurate diagnosis is best achieved via a detailed history, physical examination, selected testing, and neurology and/or psychiatry evaluation.
  • Epidemiology
    • Estimated incidence rate ranges from 1.5 to 5 per 100,000 persons per year.
    • Estimate prevalence 2 to 33 per 100,000 persons.
  • Etiology
    • Dissociative disorders and conversion disorders are felt to be the underlying cause to most episodes of PNES.

Clinical Features

Differential Diagnosis

Differential diagnosis of seizures

Seizure

Evaluation

Management

  • Avoid invasive medical procedures
  • Some patients will improve after they are told the diagnosis in a compassionate, non-jugdemental fashion.
  • If new diagnosis or diagnostic uncertainty consider admission for neurology consult and video EEG.
  • Psychiatric intervention is the main treatment modality for PNES. (e.g. outpatient cognitive behavioral therapy (CBT)).
    • The purpose of psychiatric consultation is to identify underlying psychiatric conditions that can help direct treatment.

Disposition

  • If symptoms improve consider discharge with close neurology and psychiatry follow-up to rule out epilepsy and identify and treat the underlying psychiatric origin of symptoms.
  • If symptoms cannot be controlled or patient/family are not accepting of diagnosis. Consider admission for observation and further evaluation.
  • Prognosis:
    • 25-38 percent of patients achieve seizure freedom
    • Children have a better prognosis than adults, with 70 to 80 percent achieving seizure remission

See Also

External Links

References