Difference between revisions of "Psychogenic nonepileptic seizure"

(References)
(Management)
Line 13: Line 13:
  
 
==Management==
 
==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==
 
==Disposition==

Revision as of 19:58, 1 June 2018

Background

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