Psychogenic nonepileptic seizures

Psychogenic nonepileptic seizures (PNES) are a common presentation to the emergency room and neurology department. They are often misdiagnosed and treated as epileptic seizures. Inappropriate treatment leads to poor patient outcomes and iatrogenic complications, as the underlying mechanisms and treatments are distinctly different. Most causes involve a conversion or dissociative reaction to a prior traumatic experience or abuse. Recognition of the characteristic clinical features of PNES and utilization of video-electroencephalography to confirm the diagnosis is critical. Discontinuation of treatment for epilepsy (unless comorbid PNES and epilepsy is present), acceptance of the diagnosis, and a multidisciplinary treatment plan with clinical psychologists, neurologist, and psychiatrist improve patient and healthcare outcomes.