title: A clinically oriented perspective on psychogenic nonepileptic seizure-related emergencies.
abstract: Psychogenic nonepileptic seizures (PNES) can present emergently and are often mistaken for epileptic seizures. PNES emergencies have not been well studied, and yet there are associated serious morbidities, particularly when patients are seen in an emergency setting and are misdiagnosed. PNES may be prolonged, mimicking status epilepticus, a condition we refer to as nonepileptic psychogenic status (NEPS), and patients may receive aggressive and unnecessary medical treatments that can lead to serious iatrogenic complications, including death. NEPS is also associated with an increased risk of self-harm, including suicide attempts, and may indicate a serious comorbid psychiatric illness. In addition to iatrogenic complications of PNES, accidents and injuries are an underrecognized source of morbidity. PNES may also present during medical procedures, which may not only interfere with their completion, but may alarm practitioners who, fearing liability, may initiate further medical evaluations and treatments. When PNES occur during pregnancy, patients may be misdiagnosed with eclampsia and their offspring delivered prematurely. They also risk being placed on medications that are harmful to the fetus. Increased awareness of PNES is necessary to prevent iatrogenic harm and to identify underlying psychiatric illnesses that carry their own risks. As yet, data available to guide treatment are scant, and further study is needed.
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA bdworetzky@partners.org.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Dworetzky
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Weisholtz
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Perez
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Gaston
authors.initials: G
authors.lastname: Baslet
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D003291:Conversion Disorder / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000187:drug effects; D004630:Emergencies; D004636:Emergency Service, Hospital; D004827:Epilepsy / Q000175:diagnosis* / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy; D005260:Female; D006801:Humans; D011247:Pregnancy; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D019564:Unnecessary Procedures
chemical_list: D000927:Anticonvulsants
keywords: accidents; nonepileptic psychogenic status; pregnancy; pseudostatus; suicide