Psychogenic non-epileptic seizures: Make the diagnosis unequivocally
Nitin K.Sethi, Associate Professor of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center (New York, NY)
Published January 13, 2019
I read with interest the editorial by Dr. Benbadis and the corresponding article by Tolchin et al.1,2 One reason why psychiatrists and psychologists resist accepting the care of patients with psychogenic non-epileptic seizures (PNES) is the failure of the diagnosing neurologist to confirm the diagnosis unequivocally. Many times we, as epileptologists, are guilty of saying that the patient suffers from PNES, but—because an EEG in the remote past was read as abnormal—a seizure disorder cannot be ruled out. This creates a diagnostic conundrum and treatment dilemma for both the patient and the psychiatrist. Whenever a diagnosis of PNES is made, we—as neurologists—should make a sincere attempt to rule out or rule in coexisting seizure disorder.
References
Benbadis SR. Psychogenic nonepileptic seizures, conversion, and somatic symptom disorders. Neurology Epub 2019 Jan 4.
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.
I read with interest the editorial by Dr. Benbadis and the corresponding article by Tolchin et al.1,2 One reason why psychiatrists and psychologists resist accepting the care of patients with psychogenic non-epileptic seizures (PNES) is the failure of the diagnosing neurologist to confirm the diagnosis unequivocally. Many times we, as epileptologists, are guilty of saying that the patient suffers from PNES, but—because an EEG in the remote past was read as abnormal—a seizure disorder cannot be ruled out. This creates a diagnostic conundrum and treatment dilemma for both the patient and the psychiatrist. Whenever a diagnosis of PNES is made, we—as neurologists—should make a sincere attempt to rule out or rule in coexisting seizure disorder.
References
Footnotes
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