Psychogenic Seizures in Adolescents: An "Evergreen" Diagnostic Challenge

Abstract

Psychogenic non-epileptic seizures (PNES) are not associated with abnormal brain EEG activity and cannot be explained by other neurological disorders. PNES are also defined as functional neurological disorders and are included among the Conversion Disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There is no doubt about the importance of an early and correct diagnosis of PNES. Diagnostic process is first based on an accurate clinical history. Video-EEG is considered the gold standard for the diagnosis, though it is often time consuming and it does not always allow to record an ictal event. When PNES is diagnosed, because it is not a seizure and no emergency treatment is required, the first goal is to ensure acceptance of the diagnosis. Initially, putative precipitating stressors need to be identified and addressed so that PNES can be contained and managed. Possible interventions for patients with PNES include psychotherapy, family counseling interventions, changes in the school environment and drug treatment. The latter may include anxyolytics and/or antidepressants; in case of a comorbid ADHD disorder, methylphenidate may be also considered.