Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • COVID-19
    • Practice Current
    • Practice Buzz
    • Without Borders
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • COVID-19
    • Practice Current
    • Practice Buzz
    • Without Borders
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Author response to Dr. Sethi: Psychogenic seizures and comorbid epilepsy

  • Benjamin Tolchin, Neurologist, Yale Comprehensive Epilepsy Center
  • Barbara A. Dworetzky, Neurologist, Brigham and Women's Hospital
  • Steve Martino, Psychologist, Yale University School of Medicine
  • Hal Blumenfeld, Neurologist, Yale Comprehensive Epilepsy Center
  • Lawrence J. Hirsch, Neurologist, Yale Comprehensive Epilepsy Center
  • Gaston Baslet, Psychiatrist, Brigham and Women's Hospital
Submitted January 24, 2019

We appreciate Dr. Sethi's important reminder that it is the responsibility of neurologists to diagnose both psychogenic nonepileptic seizures (PNES) and epilepsy, and—in cases of PNES—to rule out or rule in comorbid epilepsy. Making as definite a diagnosis is possible, and communicating the diagnosis clearly to the patient and to the treating behavioral specialists is essential to the treatment of PNES. An ambiguous diagnosis can undermine the confidence of the patient and behavioral health specialists in the psychotherapeutic process, leading to nonadherence.

This is why it is important, whenever possible, to capture all typical spells on video electroencephalogram (EEG) during spell characterization, as recommended by the International League Against Epilepsy Nonepileptic Seizures Task Force.1,2 Additionally in situations like those described by Dr. Sethi, in which a prior EEG was read as abnormal, we recommend that the current neurologist obtain and review the original EEG, as normal EEG activity is frequently overread as epileptiform abnormalities.3 While comorbid PNES plus epilepsy does exist in a small minority of cases, it is not the common occurrence that older research suggested.4 It is important that a prior overread EEG not be allowed to confuse an otherwise clear diagnosis of PNES and thereby undermine treatment.

References

  1. Tolchin B, Dworetzky BA, Martino S, Blumenfeld H, Hirsch LJ, Baslet G. Adherence with psychotherapy and treatment outcomes with psychogenic nonepileptic seizures. Neurology Epub 2019 Jan 4.
  2. LaFrance WC Jr, Baker GA, Duncan R, Goldstein LH, Reuber M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia 2013;54:2005–2018.
  3. Benbadis SR. "Just like EKGs!" Should EEGs undergo a confirmatory interpretation by a clinical neurophysiologist? Neurology 2013;80:S47–S51.
  4. Kutlubaev MA, Xu Y, Hackett ML, Stone J. Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: Systematic review and meta-analysis of frequency, correlates, and outcomes. Epilepsy Behav 2018;89:70–78.

Footnotes

For disclosures, please contact the editorial office at journal@neurology.org.

Navigate back to article

Neurology: 96 (2)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2021 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise