Patients with PNES are prone to more somatic symptoms than the healthy control group or patients with epilepsy. 28 Several comorbidities are usually present, especially mood, anxiety and sleep disorders, personality disorders, chronic pain other disorders with somatic symptoms. 27, 41, 42 Some authors have conceptualized PNES as manifestations of PTSD 43 however, only half of the patients with PNES have PTSD. 40 As noted above, PTSD and history of traumatic events are highly prevalent among patients with PNES. 26, 31, 38, 39 However, Kalogjera-Sackellares (1996) described two leading “causes” of PNES: post-traumatic PNES, acute or distant trauma, and developmental PNES emotional deprivation or psychological trauma during developmental periods. 36, 37 Some researchers describe patients with PNES is a heterogeneous group. 24, 31, 32 Psychobiological studies have shown that patients with PNES may be less tolerant of emotional arousal 33 and show high alexithymia (difficulty identifying and describing internal emotional experiences), 3, 34, 35 dissociation, 6, 36 somatization rates, 3 and tendencies to avoid emotions altogether. 30 Recent advances in the search for possible neurophysiological biomarkers in functional MRI studies indicate abnormalities in emotional, cognitive, executive, and sensorimotor neuronal circuits. 27–29 Patients with PNES are characterized by difficulty verbalizing their emotions, especially when anxious and manifest them via somatic symptoms instead. It occurs in up to 84% of these patients. 26, 27 Physical or sexual abuse in anamnesis is frequent. 25Īlso, the pathophysiology of PNES is not well understood. However, there are also situations where even long-term follow-up does not lead to the recording of typical seizures. 24 Unfortunately, this can lead to an unnecessary overlook of PNES diagnosis as vEEG usually detects seizures that do not have EEG correlates of the epileptic activity. 22–24 Although the diagnosis should be made by video electroencephalograph (vEEG), most health care providers do not use this test. 21, 22 The delayed diagnosis is then associated with poor prognosis. 8, 21 In some studies, the diagnosis of PNES is delayed up to nine years after the onset of symptoms. 20ĭespite advances in diagnostic and evidence-based treatment, current knowledge about PNES has not been sufficiently translated into clinical practice. In a 10-year follow-up study, the treatment outcome was rated as poor in 44% of patients (seizures persisted or patients remained dependent on care). 18, 19 Their prospective treatment outcomes are not favourable. Patients with PNES have high health care consumption, and they are reaching a level of disability in everyday life similar to that of patients with epilepsy. 15 PNES are more prevalent in women, most of whom are aged between 15 and 35 years. 11–14 The prevalence estimates are further complicated by common comorbidity between PNES and epilepsy that occurs in 20% to 60% of the individuals with epilepsy. 6–8 The diagnosis of PNES is also made in 20 to 50% of inpatients in departments specialized in epilepsy 9, 10 and can be present in up to 25% of patients treated for refractory epilepsy. 5 PNES is a complex neuropsychiatric disorder at the border of neurological and psychiatric disciplines that has been largely overlooked and avoided by mental health providers. PNES can be confused with partial or generalized epileptic seizures, and the patient may continue to communicate with the environment or stop responding. 2–4 PNES episodes may include motor behaviour, intrinsic sensory or cognitive deviations. 1 They manifest with paroxysmal, sudden changes in motor activity, behaviour, cognitive processing with changes in consciousness, or autonomic functions associated with dysfunction in the processing of anxiety. These dissociative seizures (otherwise psychogenic nonepileptic seizures, PNES) are, according to DSM-5, a type of the conversion disorder belonging to the functional neurological symptom disorders (FNSD). Most of these patients suffer from dissociative seizures, otherwise known as “nonepileptic seizures”. As many as one-fifth of patients, who show up at specialized neurological departments with seizures do not meet the diagnostic criteria for epilepsy.
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