Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium?

Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium?

Gaston BasletDepartment of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USAAbstract: Psychogenic nonepileptic seizures (PNES) can significantly affect an individual’s quality of life, the health care system, and even society. The first dec...

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Autor principal: Baslet G
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2012
Materias:
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
Acceso en línea:https://doaj.org/article/921c01a1cddc4345841101f8b06502e3
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spelling oai:doaj.org-article:921c01a1cddc4345841101f8b06502e32021-12-02T02:55:03ZPsychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium?1176-63281178-2021https://doaj.org/article/921c01a1cddc4345841101f8b06502e32012-12-01T00:00:00Zhttp://www.dovepress.com/psychogenic-nonepileptic-seizures-a-treatment-review-what-have-we-lear-a11709https://doaj.org/toc/1176-6328https://doaj.org/toc/1178-2021Gaston BasletDepartment of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USAAbstract: Psychogenic nonepileptic seizures (PNES) can significantly affect an individual’s quality of life, the health care system, and even society. The first decade of the new millennium has seen renewed interest in this condition, but etiological understanding and evidence-based treatment availability remain limited. After the diagnosis of PNES is established, the first therapeutic step includes a presentation of the diagnosis that facilitates engagement in treatment. The purpose of this review is to present the current evidence of treatments for PNES published since the year 2000 and to discuss further needs for clinical treatment implementation and research. This article reviews clinical trials that have evaluated the efficacy of structured, standardized psychotherapeutic and psychopharmacological interventions. The primary outcome measure in clinical trials for PNES is event frequency, although it is questionable whether this is the most accurate indicator of functional recovery. Cognitive behavioral therapy has evidence of efficacy, including one pilot randomized, controlled trial where cognitive behavioral therapy was compared with standard medical care. The antidepressant sertraline did not show a significant difference in event frequency change when compared to placebo in a pilot randomized, double-blind, controlled trial, but it did show a significant pre- versus posttreatment decrease in the active arm. Other interventions that have shown efficacy in uncontrolled trials include augmented psychodynamic interpersonal psychotherapy, group psychodynamic psychotherapy, group psychoeducation, and the antidepressant venlafaxine. Larger clinical trials of these promising treatments are necessary, while other psychotherapeutic interventions such as hypnotherapy, mindfulness-based therapies, and eye movement desensitization and reprocessing may deserve exploration. Flexible delivery of treatment that considers the heterogeneous backgrounds of patients is emphasized as necessary for successful outcomes in clinical practice.Keywords: conversion disorder, therapeutics, clinical trials, psychotherapeutic interventions, psychopharmacological interventionsBaslet GDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2012, Iss default, Pp 585-598 (2012)
institution DOAJ
collection DOAJ
language EN
topic Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
spellingShingle Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
Baslet G
Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium?
description Gaston BasletDepartment of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USAAbstract: Psychogenic nonepileptic seizures (PNES) can significantly affect an individual’s quality of life, the health care system, and even society. The first decade of the new millennium has seen renewed interest in this condition, but etiological understanding and evidence-based treatment availability remain limited. After the diagnosis of PNES is established, the first therapeutic step includes a presentation of the diagnosis that facilitates engagement in treatment. The purpose of this review is to present the current evidence of treatments for PNES published since the year 2000 and to discuss further needs for clinical treatment implementation and research. This article reviews clinical trials that have evaluated the efficacy of structured, standardized psychotherapeutic and psychopharmacological interventions. The primary outcome measure in clinical trials for PNES is event frequency, although it is questionable whether this is the most accurate indicator of functional recovery. Cognitive behavioral therapy has evidence of efficacy, including one pilot randomized, controlled trial where cognitive behavioral therapy was compared with standard medical care. The antidepressant sertraline did not show a significant difference in event frequency change when compared to placebo in a pilot randomized, double-blind, controlled trial, but it did show a significant pre- versus posttreatment decrease in the active arm. Other interventions that have shown efficacy in uncontrolled trials include augmented psychodynamic interpersonal psychotherapy, group psychodynamic psychotherapy, group psychoeducation, and the antidepressant venlafaxine. Larger clinical trials of these promising treatments are necessary, while other psychotherapeutic interventions such as hypnotherapy, mindfulness-based therapies, and eye movement desensitization and reprocessing may deserve exploration. Flexible delivery of treatment that considers the heterogeneous backgrounds of patients is emphasized as necessary for successful outcomes in clinical practice.Keywords: conversion disorder, therapeutics, clinical trials, psychotherapeutic interventions, psychopharmacological interventions
format article
author Baslet G
author_facet Baslet G
author_sort Baslet G
title Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium?
title_short Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium?
title_full Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium?
title_fullStr Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium?
title_full_unstemmed Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium?
title_sort psychogenic nonepileptic seizures: a treatment review. what have we learned since the beginning of the millennium?
publisher Dove Medical Press
publishDate 2012
url https://doaj.org/article/921c01a1cddc4345841101f8b06502e3
work_keys_str_mv AT basletg psychogenicnonepilepticseizuresatreatmentreviewwhathavewelearnedsincethebeginningofthemillennium
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