Psychogenic Nonepileptic Seizures: Diagnosis, Management, and Bioethics

Abstract Background The diagnosis and management of psychogenic nonepileptic seizures (PNES) is often challenging and fraught with discord and disagreement between patients, parents, and physicians. Furthermore, there are ethical challenges when making the diagnosis, communicating this information,...

Full description

Saved in:
Bibliographic Details
Published in:Pediatric neurology 2016-09, Vol.62, p.3-8
Main Authors: Takasaki, Kaoru, BA, Diaz Stransky, Andrea, MD, Miller, Geoffrey, MA, MB, MPhil, MD, FRCP, FRACP
Format: Article
Language:English
Subjects:
Bioethical Issues
bioethics
Humans
Neurology
non-epileptic seizures
Pediatrics
PNES
psychogenic seizures
Psychophysiologic Disorders - diagnosis
Psychophysiologic Disorders - physiopathology
Psychophysiologic Disorders - therapy
Seizures - diagnosis
Seizures - physiopathology
Seizures - therapy
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background The diagnosis and management of psychogenic nonepileptic seizures (PNES) is often challenging and fraught with discord and disagreement between patients, parents, and physicians. Furthermore, there are ethical challenges when making the diagnosis, communicating this information, and instituting management. Methods We reviewed the current body of knowledge regarding the characteristic differences between epileptic seizures and PNES, and the high incidence of psychiatric comorbidities. An ethical analysis was made of diagnosis and management based on ethical principles, virtue ethics, and the social contract that health professionals have with patients. Results Key distinctions between PNES and epilepsy lie in both patient and seizure characteristics. Long duration, eye closure, asynchronous movements, frequent recurrence in the same context, intra-ictal awareness, and lack of post ictal state are useful in helping establish the diagnosis. Psychiatric comorbidities, history of abuse, cognitive impairment, and multiple non specific somatic complaints are some salient patient features that should increase suspicion for the diagnosis of PNES. However, definitive diagnosis rests on capturing the events on video EEG. Conclusion Effective diagnosis and management of PNES requires the use of video EEG and an early collaborative approach between pediatricians, neurologists, psychiatrists, nursing staff, and other professional colleagues. Ethical questions that may arise should be addressed with the virtues of competence, courage, compassion, prudence, and honesty; and the principles of respect beneficence, and the avoidance of unnecessary harm.
ISSN:0887-8994
1873-5150
DOI:10.1016/j.pediatrneurol.2016.04.011