Psychogenic non-epileptic seizures in clinical practice
Magdalena Gugała-Iwaniuk, Anna Bochyńska, Halina Sienkiewicz-Jarosz
Psychogenic non-epileptic seizures are an important clinical problem. They are defined as paroxysmal motor, sensory, autonomic, cognitive and behavioural manifestations that resemble seizures but are caused by complex neuropsychiatric factors rather than changes in the brain’s bioelectrical activity. Accurate diagnosis and treatment of psychogenic non-epileptic seizures require an interdisciplinary approach based on the collaboration between neurologists, psychologists and psychiatrists. The aim of this paper is to present the current knowledge and to review research on psychogenic non-epileptic seizures. It discusses the epidemiology and nosological position of psychogenic seizures, which are included in the class of dissociative disorders or disorders with somatic symptoms in the international classifications of diseases. The mechanisms and triggers of psychogenic seizures, along with attempts to classify the disorder in terms of the clinical picture, as well as the semiology of the most common seizure events and the diagnostic criteria for psychogenic non-epileptic seizures are described. Furthermore, the paper presents data on the usefulness of different tools in the diagnosis of suspected psychogenic incidents, such as EEG and video-EEG tests, neuroimaging, laboratory tests and psychological evaluations. We also point to diagnostic difficulties arising from the coexistence of psychogenic non-epileptic seizures and epilepsy. Finally, we present the recommendations of experts on possible treatment approaches, including pharmacotherapy and psychotherapy.