Psychogenic non-epileptic seizures (PNES)

Pages: 492-494
Priyesh Kumar Singh and Tara Singh (Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh)
Vijay Nath Mishra and Ranjeet Kumar Singh (Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh)

Psychogenic non-epileptic seizures (PNES) are episodes of altered movement, sensation or experience which are similar to epilepsy but caused by psychological process and not associated with abnormal discharges in the brain. Because of its somatic and psychiatric manifestation it neither falls in medical nor in mental health domain. Mostly, PNES are frequently misdiagnosed as epileptic seizures which risks patient’s life. The global prevalence of PNES is estimated to about 2-33%/100,000 per year. Moreover, patient referred to epilepsy care unit of which 5 to 33% are PNES, 10 to 40% (PNES) of refractory seizures, among which mostly are women (75%) with age range of 20 to 30 years. Diagnosis of PNES is complicated by possible co-morbidity with epilepsy and other somatic co-morbidities like chronic pain, headache, sleep disturbances, asthma, obesity and other psychiatric disorders. The gold standard to diagnose patient of PNES is video-encephalography (V-EEG) although it has pitfalls. No single mechanism of event or contributing factor has been identified to be necessary to explain PNES, usually it is assumed as an unintentional manifestation of emotional distress which can be explained on the basis of neurophysiological, psychological and social base. Till now no accepted protocol for the treatment of PNES exists because of varied underlying mechanism that have triggered PNES and which do exist is not for long period and differs individually. The future suggested treatment intervention should include these three arms i.e. neurological, cognitive-behavioural and psychopharmacological intervention.