Psychogenic nonepileptic seizures: acute change in
event frequency after presentation of the diagnosis
Sarah Tomaszewski Farias,
*
Catherine Thieman, and Taoufik M. Alsaadi
Epilepsy Treatment Center, University of California, Davis, Sacramento, CA 95817, USA
Received 27 January 2003; revised 22 May 2003; accepted 23 May 2003
Abstract
Seizure frequency during inpatient video EEG monitoring was examined before and after the diagnosis of psychogenic
nonepileptic seizures (PNES) was presented to patients (N ¼ 22). A control group of 10 patients with epileptic seizures (ES) were
also followed from pre- to postdiagnosis. The number of PNES or ES within the 24-hour period prior to diagnosis was compared
with the number of events that occurred within the 24-hour period after presentation of the diagnosis. Findings indicate that patients
with PNES had a significant decrease in the frequency of events after diagnosis, while those with ES showed no change in event
frequency after diagnosis. Eighteen of twenty-two patients with PNES had no further events during an acute follow-up period.
Results suggest that providing patients with a diagnosis of PNES appears to reduce the acute frequency of PNES and may be an
important first step in the long-term remediation of PNES. Long-term follow-up is needed to determine if such feedback alters the
course of the disorder.
Ó 2003 Elsevier Science (USA). All rights reserved.
Keywords: Nonepileptic seizures; Psychogenic seizures
1. Introduction
Psychogenic nonepileptic seizures (PNES) encompass
a diverse group of disorders in which paroxysmal events
are not caused by an epileptic disorder [1]. PNES is
common, with estimates ranging from 3 to 20% of pa-
tients referred to epilepsy centers ending up with a di-
agnosis of PNES [2–4]. The introduction and widespread
use of video electroencephalographic (vEEG) telemetry
has revolutionized the clinicianÕs ability to accurately
diagnose PNES [5]. Despite advances in the ability to
diagnose PNES, comparatively little progress has been
made in developing treatment strategies to remediate the
problem once it has been accurately diagnosed. One
problem in the development of approaches to treatment
of PNES has to do with the heterogeneity of the under-
lying psychogenic mechanisms by which PNES can de-
velop. Psychiatric disorders that can be associated with
PNES include conversion disorders, dissociative disor-
ders, depression, and anxiety disorders [1,6–8]. Given
this heterogeneity in psychopathology, it is not surpris-
ing that treatment of PNES is complicated and likely
dependent, to a large extent, on the underlying psycho-
pathology present. As such, many aspects of treatment
will vary considerably from patient to patient. However,
we believe that there are some common aspects of
treatment that can be applied to the majority of patients,
one of which is the presentation of the diagnosis in a
systematic, detailed, and nonthreatening way. This is a
very important first step in treatment. In fact, it has been
noted by some authors that simply making the diagnosis
and providing some basic education about the nature of
disorder can lead to a long-term remission of symptoms
without further treatment [9,10].
The manner in which the diagnosis is presented to the
patient likely has important ramifications on the course
of the disorder. Shen and his colleagues [11] developed a
protocol for presenting the diagnosis of PNES to pa-
tients that focuses on accurately conveying the nonepi-
Epilepsy & Behavior 4 (2003) 424–429
www.elsevier.com/locate/yebeh
Epilepsy
&
Behavior
*
Corresponding author. University of California, Davis, Medical
Center, Department of Neurology, 4860 Y Street, Suite 3700,
Sacramento, CA 95817, USA. Fax: 1-916-456-9350.
E-mail address: sarah.farias@ucdmc.ucdavis.edu (S.T. Farias).
1525-5050/$ - see front matter Ó 2003 Elsevier Science (USA). All rights reserved.
doi:10.1016/S1525-5050(03)00143-4