A brief update on psychogenic non-epileptic seizures: a challenge to overcome

Psychogenic Non-Epileptic Seizures (PNES) are defined by their semiological resemblance to Epileptic Seizures (ES), not associated with specific epileptic discharges in an ictal EEG. PNES are, in fact, a feature of an underlying psychiatric disorder even if these patients are currently in the realm of epileptologists and for these reasons there is a large degree of confusion underlying the diagnosis (with an average delay of 3 years) and management of PNES. Documented PNES diagnosis would require the attack captured on video EEG (vEEG), but often it is not possible. The video registration of a seizure seen by an expert would make PNES “probable”. Conversational analysis has been demonstrated to be a very useful tool in the differential diagnosis between PNES and ES with a good rate of reliability. From a psychological point of view, PNES could be the same phenotype of different underlying mechanisms and, also for this reason, should consider these underlying processes and treatment could be sometimes seriously deficient. Many psychological approaches are anecdotally reported, but controlled studies are still lacking, and interventions still rely on clinicians’ experience. Moreover, pharmacological treatment may be recommended in adults or elderly with concomitant anxiety or depression. In conclusion, many symptoms and signs are valid but none is pathognomonic, the symptoms should be reported correctly and psychiatrists should be necessarily involved for the correct diagnosis and management of PNES.