The International League Against Epilepsy (ILAE) Neuropsychobiology Commission gave the charge to provide practical guidance for health professionals for the pharmacologic and nonpharmacologic treatment of patients with psychogenic nonepileptic seizures (PNES). Using a consensus review of the literature, an international group of clinician-researchers in epilepsy, neurology, neuropsychology, and neuropsychiatry evaluated key management approaches for PNES. These included the following: presentation of the diagnosis, early phase treatment, psychological and pharmacologic interventions, and maintenance management. The aim of this report is to provide greater clarity about the range and current evidence base for treatment for patients with PNES, with the intention of improving the care of patients with PNES and patients who develop PNES as a comorbidity of epilepsy.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/epi.12106

Management of psychogenic nonepileptic seizures.

Psychogenic nonepileptic seizures

Purpose The aim of this meta-analysis is to evaluate and synthesize the available evidence from the previous 20 years regarding the utility of psychological interventions in the management of psychogenic non-epileptic seizures (PNES). Method Studies were retrieved from MEDLINE via OvidSP and PsychINFO. Selection criteria included controlled and before-after non-controlled studies including case series, using seizure frequency as an outcome measurement. Studies were required to assess one or more types of psychological intervention for the treatment of PNES in adults. Data from 13 eligible studies was pooled to examine the effectiveness of psychological interventions in treating PNES on two primary outcomes: seizure reduction of 50% or more and seizure freedom. A meta-analysis was conducted with data extracted from 228 participants with PNES. Results Interventions reviewed in the analysis included CBT, psychodynamic therapy, paradoxical intention therapy, mindfulness and psychoeducation and eclectic interventions. Meta-analysis synthesized data from 13 studies with a total of 228 participants with PNES, of varied gender and age. Results showed 47% of people with PNES are seizure free upon completion of a psychological intervention. Additional meta-analysis synthesized data from 10 studies with a total of 137 participants with PNES. This analysis found 82% of people with PNES who complete psychological treatment experience a reduction in seizures of at least 50%. Conclusion The studies identified for this analysis were diverse in nature and quality. The findings highlight the potential for psychological interventions as a favorable alternative to the current lack of treatment options offered to people with PNES.

Psychological interventions for psychogenic non-epileptic seizures: A meta-analysis

Psychogenic nonepileptic seizures (PNES) resemble epilepsy, but no pathophysiological explanation has been established. Although there have been recent advances in PNES research and various hypotheses as to the psychopathology, no theory has achieved general acceptance. In this overview of selected literature on PNES, we highlight the often contradictory findings that underline the challenges that confront both practitioner and researcher. We first provide a synopsis of the history, diagnosis, treatment, and outcomes, as well as patient characteristics of PNES and the relevance of communication in the clinical context. In the subsequent sections we discuss recent research that may advance the understanding and diagnosis of this disorder. These themes include the use of qualitative methods as a viable research option, the application of nonlinear methods to analyze heterogeneous observations during diagnosis, recent advances in neuroimaging of PNES, and the development of international databases.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1528-1167.2012.03606.x

Psychogenic nonepileptic seizures: A current overview

https://www.asuemotionlab.com/wp-content/uploads/2012/02/DimaroDawsonRobertsetal2014ImpExpAnxPNES.pdf

D. Wittenberg

Papers

Group therapy for patients with psychogenic nonepileptic seizures: a pilot study.