A review of the clinical approach and challenges to psychogenic non-epileptic seizures

Psychogenic non-epileptic seizures (PNES) is a relevant differential diagnosis in epilepsy clinics because of its high prevalence and impact on patient’s lives and health care services. An approach to the diagnosis and treatment of PNES is important, and many issues make the subject challenging. Video electroencephalography (VEEG) is considered the gold-standard for PNES diagnosis but there is still risk for false positive and false negative results, both with potential dire consequences. VEEG should be planned and analyzed with caution, as well as paired with other clinical variables in order to increase its predictive value. The frequent coexistence of epilepsy among PNES patients makes diagnosis and treatment even more complex. The clinician should always mind that possibility, which has important implications for diagnosis and treatment of the PNES. Patients’ understanding and acceptance of the disorder as well as health care professionals’ attitude towards the patients have impact on prognosis. Proper and coherent communication is important for patients’ acceptance of diagnosis, treatment, and prognosis.