Evidence-Based Practice for the Clinical Assessment of Psychogenic Nonepileptic Seizures: A Report From the American Neuropsychiatric Association Committee on Research

Research output: Contribution to journalArticlepeer-review

Authors

  • Gaston Baslet
  • Sepideh N Bajestan
  • Selma Aybek
  • Mandana Modirrousta
  • Jason Price D Clin Psy
  • David L Perez
  • Shelby Scott Lazarow
  • Geoffrey Raynor
  • Valerie Voon
  • Simon Ducharme
  • W Curt LaFrance

External organisations

  • Brown University
  • Department of General Psychiatry
  • BRIGHAM AND WOMEN'S HOSPITAL
  • Harvard Medical School
  • Boston (Baslet)
  • Department of Psychiatry and Behavioral Sciences and Behavioral Sciences Laboratories, University of Oklahoma Health Sciences Center
  • Department of Surgery, Stanford University School of Medicine, Stanford, CA.
  • VA Palo Alto Healthcare System; Palo Alto CA USA
  • Calif. (Bajestan)
  • Department of Paediatric Neurology
  • Inselspital University Hospital and Clinical Neuroscience Bern Network
  • University Institute of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Switzerland (Aybek)
  • University of Manitoba Winnipeg, Manitoba, Canada.
  • Innovative Biodiagnostics Winnipeg Canada
  • Foundation MBBM, Hemato-Oncology Center, University of Milano-Bicocca, Via Cadore 38, 20900 Monza, MB, Italy.
  • Canada (Modirrousta)
  • South Tees Hospitals National Health Service Foundation Trust
  • MIDDLESBROUGH COUNCIL
  • United Kingdom (Price)
  • Department of Neuropsychiatry
  • United Kingdom (Cavanna)
  • Departments of Psychiatry, Neurology and Radiology, Washington University School of Medicine, St. Louis, MO, USA.
  • Functional Neurology Research Group
  • Massachusetts General Hospital
  • Boston (Perez)
  • Division of Hepatology and Liver Transplantation, California Pacific Medical Center, San Francisco, California.
  • San Francisco (Lazarow)
  • Boston (Raynor)
  • Cancer Research UK Cambridge Institute
  • United Kingdom (Voon)
  • Montreal Neurological Institute
  • McGill University
  • Montreal (Ducharme)
  • Pulmonary and Critical Care Medicine Alpert Medical School of Brown University, Rhode Island Hospital, Providence, USA.
  • Providence Colllege

Abstract

The American Neuropsychiatric Association's Committee on Research assigned the task of defining the most helpful clinical factors and tests in establishing the diagnosis of psychogenic nonepileptic seizures (PNES) during a neuropsychiatric assessment. A systematic review of the literature was conducted using three search engines and specified search terms for PNES and the predetermined clinical factors and diagnostic tests, followed by a selection process with specific criteria. Data extraction results from selected articles are presented for clinical factors (semiology, psychiatric comorbidities, medical comorbidities, psychological traits) and diagnostic tests (EEG, psychometric and neuropsychological measures, prolactin level, clinical neuroimaging, autonomic testing). Semiology with video EEG (vEEG) remains the most valuable tool to determine the diagnosis of PNES. With the exception of semiology, very few studies revealed the predictive value of a clinical factor for PNES, and such findings were isolated and not replicated in most cases. Induction techniques, especially when coupled with vEEG, can lead to a captured event, which then confirms the diagnosis. In the absence of a captured event, postevent prolactin level and personality assessment can support the diagnosis but need to be carefully contextualized with other clinical factors. A comprehensive clinical assessment in patients with suspected PNES can identify several clinical factors and may include a number of tests that can support the diagnosis of PNES. This is especially relevant when the gold standard of a captured event with typical semiology on vEEG cannot be obtained.

Details

Original languageEnglish
Pages (from-to)appineuropsych19120354
JournalJournal of Neuropsychiatry
Publication statusE-pub ahead of print - 11 Aug 2020