In all the medical settings that I have worked in, both clinical and trauma, I have experienced patients with PNES. It is necessary to understand and report this phenomenon correctly in order to provide appropriate treatment.
Psychogenic non-epileptic seizures (PNES) are episodes that look like epileptic seizures but are not caused by abnormal electrical activity in the brain. Unlike epileptic seizures, PNES are thought to be caused by psychological factors such as stress, trauma, drug abuse or emotional issues. These episodes are often misdiagnosed as epilepsy. They can appear as generalized convulsions, temporary loss of attention, or staring. They also differ from epileptic seizures in that they do not respond to anti-seizure medications and can often last longer. The most reliable way to diagnose PNES is with video EEG monitoring. The episodes are recorded over a period of time. The video EEG helps the physician monitor the patient’s behavior on camera and correlate it with brain activity to confirm whether abnormal brain waves are associated with the event.
It can be harmful to treat someone who is having PNES the same way as someone that is having epileptic seizures. Patients can suffer from adverse reactions when they might not need medication. Treatment options for PNES may include keeping a healthy diet, exercise, and psychotherapy. When treating PNES, it is important to treat the underlying cause of the mental stressors since that is what has manifested as the physical symptoms. If PNES is left untreated, it can impact the quality of life for the patient, disrupt relationships, and daily activities.
Some patients may have both epilepsy and PNES. It is important to have mental health resources available to understand the stressors the patients may be experiencing, and to develop strategies for managing these events.
Video EEG is crucial in evaluating the patient to prevent a misdiagnosis of epilepsy. It can help avoid unnecessary ICU admission and AED (anti-epileptic drug) toxicity, which can be harmful if treated without confirmation from the EEG. It also provides a better outcome for the patient by treating the PNES events appropriately.
Written by: Christina Overton, R. EEG T
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