1. Management of psychogenic non-epileptic seizures: a multidisciplinary approach
- Author
-
S. Gasparini 1, 2, E. Beghi 3, E. Ferlazzo 1, 4, M. Beghi 5, V. Belcastro 6, K.P. Biermann 7, G. Bottini 8, G. Capovilla 9, R.A. Cervellione 10, V. Cianci 2, G. Coppola 11, C.M. Cornaggia 12, P. De Fazio1 3, S. De Masi 7, G. De Sarro 14, M. Elia 15, G. Erba 16, L. Fusco 17, A. Gambardella 1, V. Gentile1 8, A. T. Giallonardo 19, R. Guerrini 20, F. Ingravallo 22, A. Iudice 23, A. Labate 1, E. Lucenteforte 21, A. Magaudda 24, L. Mumoli 1, C. Papagno 25, G.B. Pesce 18, E. Pucci 27, P. Ricci 28, A. Romeo 29, R. Quintas 30, C. Sueri 2, G. Vitaliti 31, R. Zoia 32, U. Aguglia 1, Gasparini, S, Beghi, E, Ferlazzo, E, Beghi, M, Belcastro, V, Biermann, K, Bottini, G, Capovilla, G, Cervellione, R, Cianci, V, Coppola, G, Cornaggia, C, De Fazio, P, De Masi, S, De Sarro, G, Elia, M, Erba, G, Fusco, L, Gambardella, A, Gentile, V, Giallonardo, A, Guerrini, R, Ingravallo, F, Iudice, A, Labate, A, Lucenteforte, E, Magaudda, A, Mumoli, L, Papagno, C, Pesce, G, Pucci, E, Ricci, P, Romeo, A, Quintas, R, Sueri, C, Vitaliti, G, Zoia, R, Aguglia, U, Gasparini S., Beghi E., Ferlazzo E., Beghi M., Belcastro V., Biermann K.P., Bottini G., Capovilla G., Cervellione R.A., Cianci V., Coppola G., Cornaggia C.M., De Fazio P., De Masi S., De Sarro G., Elia M., Erba G., Fusco L., Gambardella A., Gentile V., Giallonardo A.T., Guerrini R., Ingravallo F., Iudice A., Labate A., Lucenteforte E., Magaudda A., Mumoli L., Papagno C., Pesce G.B., Pucci E., Ricci P., Romeo A., Quintas R., Sueri C., Vitaliti G., Zoia R., and Aguglia U.
- Subjects
Adult ,Male ,medicine.medical_specialty ,conversion disorder, EEG, epilepsy ,EEG ,conversion disorder ,epilepsy ,Psychophysiologic Disorder ,NO ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Seizures ,Psychogenic non-epileptic seizures ,medicine ,Psychogenic disease ,Humans ,030212 general & internal medicine ,Psychiatry ,Child ,Conversion disorder ,business.industry ,Electroencephalography ,Evidence-based medicine ,Bioethics ,medicine.disease ,Personality disorders ,Psychophysiologic Disorders ,Neurology ,Neurology (clinical) ,Anxiety ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Human ,conversion disorder, EEG, epilepsy, Adult, Child, Electroencephalography, Female, Humans, Male, Psychophysiologic Disorders, Seizures - Abstract
The International League against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic non-epileptic seizure (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized and management might differ according to age group. The objective was to reach an expert and stakeholder consensus on PNES management. A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients’ representatives was formed. The board chose five main topics regarding PNES: diagnosis; ethical issues; psychiatric comorbidities; psychological treatment; and pharmacological treatment. After a systematic review of the literature, the board met in a consensus conference in Catanzaro (Italy). Further consultations using a model of Delphi panel were held. The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizure induction was considered ethical, preferring the least invasive techniques. The board recommended looking carefully for mood disturbances, personality disorders and psychic trauma in persons with PNES and considering cognitive-behavioural therapy as a first-line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression. Psychogenic non-epileptic seizure management should be multidisciplinary. High-quality long-term studies are needed to standardize PNES management.
- Published
- 2019
- Full Text
- View/download PDF