title: Treatment of psychogenic nonepileptic seizures: updated review and findings from a mindfulness-based intervention case series.
abstract: Psychogenic nonepileptic seizures (PNES) were first described in the medical literature in the 19th century, as seizure-like attacks not related to an identified central nervous system lesion, and are currently classified as a conversion disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). While a universally accepted and unifying etiological model does not yet exist, several risk factors have been identified. Management of PNES should be based on interdisciplinary collaboration, targeting modifiable risk factors. The first treatment phase in PNES is patient engagement, which is challenging given the demonstrated low rates of treatment retention. Acute interventions constitute the next phase in treatment, and most research studies focus on short-term evidence-based interventions. Randomized controlled pilot trials support cognitive-behavioral therapy. Other psychotherapeutic and psychopharmacological interventions have been less well-studied using controlled and uncontrolled trials. Within the discussion of acute interventions, we present a preliminary evaluation for feasibility of a mindfulness-based psychotherapy protocol in a very small sample of PNES patients. We demonstrated in 6 subjects that this intervention is feasible in real-life clinical scenarios and warrants further investigation in larger scale studies. The final treatment phase is long-term follow-up. Long-term outcome studies in PNES show that a significant proportion of patients remains symptomatic and experiences continued impairments in quality of life and functionality. We believe that PNES should be understood as a disease that requires different types of intervention during the various phases of treatment.
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA gbaslet@partners.org.
authors.forename: Gaston
authors.initials: G
authors.lastname: Baslet
authors.affiliation: Harvard Medical School, Boston, MA, USA Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Dworetzky
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Department of Neurology, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Perez
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Oser
mesh_terms: D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003291:Conversion Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D003299:Cooperative Behavior; D004827:Epilepsy / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D033183:Interdisciplinary Communication; D064866:Mindfulness; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D011613:Psychotherapy; D011619:Psychotropic Drugs
chemical_list: D011619:Psychotropic Drugs
keywords: mindfulness-based psychotherapy; psychogenic nonepileptic seizures; therapeutics; treatment