title: Communicating the diagnosis of psychogenic nonepileptic seizures: The patient perspective.
abstract: Psychogenic nonepileptic seizures (PNES) are a common cause of refractory seizures. Video-electroencephalographic (EEG) monitoring has allowed PNES to be effectively distinguished from epileptic seizures. Once the diagnosis of PNES is established, neurologists face the challenge of explaining it to patients. Patients may not always receive the diagnosis well. The aim of this study is to evaluate how effectively patients receive and perceive the diagnosis of PNES. This prospective study was conducted in an eight-bed epilepsy monitoring unit (EMU). Adult patients with newly confirmed PNES were included. After receiving written consent, a self-administered questionnaire was given to patients after the attending physician had communicated the diagnosis of PNES. A total of 75 patients were recruited. All patients had their typical seizures recorded on video-EEG (range 1-12, mean 2.18). Seventy patients were satisfied with the diagnosis of PNES. Nine patients did not agree that PNES has a psychological cause. Nineteen patients thought that the EMU doctors had no clue as to the cause of their seizures and 20 thought that there was no hope for a cure of their seizures. A significant number of patients with PNES feel that there is no hope for cure of their seizures. Thorough education about PNES, properly preparing patients before discussing the diagnosis of PNES, and preferably earlier diagnosis may prevent this miscommunication and result in better outcomes. A comprehensive approach including psychological counseling and psychiatric input, evaluation and treatment, in order to bring the illness from the subconscious to the conscious level, and effective follow-up may be helpful.
authors: Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, USA. Electronic address: amir.arain@vanderbilt.edu.
authors: Amir
authors: A
authors: Arain
authors: Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, USA.
authors: Maamoon
authors: M
authors: Tammaa
authors: Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, USA.
authors: Faria
authors: F
authors: Chaudhary
authors: Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, USA.
authors: Shazil
authors: S
authors: Gill
authors: Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, USA.
authors: Syed
authors: S
authors: Yousuf
authors: Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, USA.
authors: Nandakumar
authors: N
authors: Bangalore-Vittal
authors: Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, USA.
authors: Pradumna
authors: P
authors: Singh
authors: Department of Psychiatry, Meharry Medical College, Nashville, TN, USA.
authors: Shagufta
authors: S
authors: Jabeen
authors: Department of Psychiatry, Meharry Medical College, Nashville, TN, USA.
authors: Shahid
authors: S
authors: Ali
authors: Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, USA.
authors: Yanna
authors: Y
authors: Song
authors: Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, USA.
authors: Nabil J
authors: NJ
authors: Azar
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011446:Prospective Studies; D011602:Psychophysiologic Disorders / Q000175:diagnosis*; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology*
keywords: Epilepsy; Nonepileptic seizures; Pseudoseizures; Psychogenic seizures; Spells