Epileptic Disorders


The aetiology of psychogenic non-epileptic seizures: risk factors and comorbidities Volume 21, issue 6, December 2019


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Markus Reuber on behalf of the ILAE PNES Task Force 9
1 Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Germany
2 Neuroscience Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA
3 Department of Neurology, University of Otago, Christchurch, New Zealand
4 Department of Neurology & Neurosurgery, Tbilisi State University, Tbilisi, Georgia
5 Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy Centre Psychothérapique de Nancy, Laxou, France; Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France
6 Department of Neurology, Miller School of Medicine, University of Miami, FL, USA
7 Departments of Neurology and Psychiatry, Brown Medical School, Rhode Island Hospital, Providence, USA
8 Department of Psychology, University of Stellenbosch, South Africa
9 Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
* Correspondence: Stoyan Popkirov Klinik für Neurologie, Universitätsklinikum Knappschaftskrankenhaus Bochum, In der Schornau 23-25, 44892 Bochum, Germany

Psychogenic non-epileptic seizures (PNES), also known as dissociative seizures, are paroxysms of altered subjective experience, involuntary movements and reduced self-control that can resemble epileptic seizures, but have distinct clinical characteristics and a complex neuropsychiatric aetiology. They are common, accounting for over 10% of seizure emergencies and around 30% of cases in tertiary epilepsy units, but the diagnosis is often missed or delayed. The recently proposed “integrative cognitive model” accommodates current research on experiential, psychological and biological risk factors for the development of PNES, but in view of the considerable heterogeneity of presentations and medical context, it is not certain that a universal model can capture the full range of PNES manifestations. This narrative review addresses key learning objectives of the ILAE curriculum by describing the demographic profile, common risk factors (such as trauma or acute stress) and comorbid disorders (such as other dissociative and functional disorders, post-traumatic stress disorder, depressive and anxiety disorders, personality disorders, comorbid epilepsy, head injury, cognitive and sleep problems, migraine, pain, and asthma). The clinical implications of demographic and aetiological factors for diagnosis and treatment planning are addressed.

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