Psychogenic Non-epileptic Seizures: An Update on Diagnosis and Management

Abstract

Psychogenic non-epileptic seizures (PNES) are functional neurological disorders that mimic epileptic seizures. Over the past decades, relevant advancements have been made in the diagnosis, neurobiological understanding and management of PNES. This chapter is a review about epidemiology, comorbidities, biomarkers, neurobiology and treatment of PNES. The author discusses in particular the diagnosis of PNES that is based on clinical history, semiology, presence of witness and instrumental features. Neuroimaging studies suggest that PNES may occur in a context of anatomical alterations that regulate sensorimotor functions, emotional processing, cognitive control and multimodal integration of brain functions. The gold standard of PNES instrumental assessment remains video electroencephalography, showing the absence of epileptiform activity during the event and the absence of slow activity after the event. Several studies and clinical trials have demonstrated the importance of psychological treatments and in particular cognitive behavioral therapy. Further future studies are necessary to investigate about similarities and differences between psychogenic non-epileptic seizures, real epileptic seizures and other psychosomatic disorders. We also need studies for more appropriate psychotherapies and treatment guidelines.