This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
In the article “Adherence with psychotherapy and treatment outcomes for psychogenic nonepileptic seizures,” Tolchin et al. reported that among 105 participants with documented psychogenic nonepileptic seizures (PNES), adherence with psychotherapy was associated with reduction in PNES frequency, improvement in quality of life, and decrease in emergency department visits at 12–24 months of follow-up. In response, Dr. Sethi notes that psychiatrists and psychologists may be reticent to accept care for patients with PNES when neurologists do not equivocally confirm the diagnosis. He encourages neurologists to sincerely attempt to rule in or rule out coexisting epilepsy in such cases. In their reply, the authors agree that making a definitive diagnosis is possible and that clear communication to both patients and behavioral specialists is essential to facilitate appropriate treatment and adherence. They emphasize the importance of capturing all typical spells on video-electroencephalography and suggest that neurologists review previous EEGs when there is suspicion that a previous “abnormal” EEG may have been overread to avoid clouding an otherwise clear diagnosis of PNES. Dr. Benbadis, who wrote the accompanying editorial for the article, responds in agreement with Dr. Sethi and like the authors notes that only 10%–15% of patients with PNES truly have evidence of coexisting epilepsy. He suggests that including “psychogenic” in the diagnosis is critical, unless there is doubt that there is another nonepileptic diagnosis. He wonders whether mental health professionals may not believe the diagnosis. In addition to encouraging tracking down previous EEGs of concern, he also argues that coexisting epilepsy should not be a reason to deny patients with PNES access to treatment by psychiatrists and psychologists.
In the article “Adherence with psychotherapy and treatment outcomes for psychogenic nonepileptic seizures,” Tolchin et al. reported that among 105 participants with documented psychogenic nonepileptic seizures (PNES), adherence with psychotherapy was associated with reduction in PNES frequency, improvement in quality of life, and decrease in emergency department visits at 12–24 months of follow-up. In response, Dr. Sethi notes that psychiatrists and psychologists may be reticent to accept care for patients with PNES when neurologists do not equivocally confirm the diagnosis. He encourages neurologists to sincerely attempt to rule in or rule out coexisting epilepsy in such cases. In their reply, the authors agree that making a definitive diagnosis is possible and that clear communication to both patients and behavioral specialists is essential to facilitate appropriate treatment and adherence. They emphasize the importance of capturing all typical spells on video-electroencephalography and suggest that neurologists review previous EEGs when there is suspicion that a previous “abnormal” EEG may have been overread to avoid clouding an otherwise clear diagnosis of PNES. Dr. Benbadis, who wrote the accompanying editorial for the article, responds in agreement with Dr. Sethi and like the authors notes that only 10%–15% of patients with PNES truly have evidence of coexisting epilepsy. He suggests that including “psychogenic” in the diagnosis is critical, unless there is doubt that there is another nonepileptic diagnosis. He wonders whether mental health professionals may not believe the diagnosis. In addition to encouraging tracking down previous EEGs of concern, he also argues that coexisting epilepsy should not be a reason to deny patients with PNES access to treatment by psychiatrists and psychologists.
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- © 2019 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Disputes & Debates: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.