Psychogenic Nonepileptic Seizures (PNES)

Virtual Special Editions are collections of targeted papers curated by a Guest Editor. Here Dr Gaston Baslet Brigham and Women's Hospital, Boston, US (author of the Editor's Choice article in Volume 52) talk about “Psychogenic nonepileptic seizures (PNES)”.

Psychogenic nonepileptic seizures (PNES) represents an intriguing physical manifestation that has been linked to underlying psychological and physiological processes. PNES continues to highlight how mind and body are one interconnected system that works in a way that that we still aim to understand. The last 10 years have seen great advances in the field of PNES, with clinical trials that provide evidence-based therapeutic options for patients (Carlson et al, 2017), and functional neuroimaging studies that provide a window into the pathophysiology of the disorder. Many questions remain unanswered about this disorder, in particular those that relate to the underlying cognitive and affective processes that lead to such a dramatic clinical manifestation.

In PNES, semiological signs have unquestionable value in helping establish a correct diagnosis. Whether and how these signs specifically “mean” or represent some underlying affective or cognitive process remains poorly understood. Our work on altered responsiveness in PNES is a first attempt at trying to uncover a link between these two different dimensions of our patients’ experiences: altered responsiveness as a semiological sign and affective processing as an underlying mechanism. Our study provides early evidence that the inability to tolerate strong emotions and a tendency to avoid them lead patients to involuntarily disengage cognitively, as manifested by altered responsiveness during PNES. (Baslet et al, 2017). However, these findings need corroboration.

A very interesting study by Rawlings et al was published this year in Seizure (Rawlings et al, 2017), and demonstrated that the presence of associated panic symptoms during transient loss of consciousness (TLOC) was more common in PNES than in other forms of TLOC. Do panic symptoms in PNES represent a catastrophizing style that get us closer to understanding cognitive processes underneath the “tip of iceberg” that PNES is?

We still have many questions about the cognitive and affective mechanisms underneath PNES, and we lack most answers. As our work advances, we will be able to understand the workings of our brains in assembling these functional neurological symptoms as a response to underlying cognitive and affective processes. This Virtual Special Edition also includes works that provide a glimpse into these under-explored areas, either by providing explanatory models (Reuber and Brown, 2017) or by describing psychological profiles in PNES patients (Plioplys et al, 2016; Say et al, 2015).

Ultimately, our improved understanding will help us identify individuals at risk, recognize this disorder early and provide treatments that target specific vulnerabilities and pathological mechanisms.

Gaston Baslet, M.D.

  1. Carlson P, Nicholson Perry K. Psychological interventions for psychogenic non-epileptic seizures: A meta-analysis. Seizure. 2017 Feb;45:142-150.
  2. Baslet G, Tolchin B, Dworetzky BA. Altered responsiveness in psychogenic nonepileptic seizures and its implication to underlying psychopathology. Seizure. 2017 Nov;52:162-168.
  3. Rawlings GH, Jamnadas-Khoda J, Broadhurst M, Grünewald RA, Howell SJ, Koepp M, Parry SW, Sisodiya SM, Walker MC, Reuber M. Panic symptoms in transient loss of consciousness: Frequency and diagnostic value in psychogenic nonepileptic seizures, epilepsy and syncope. Seizure. 2017 May;48:22-27.
  4. Reuber M, Brown RJ. Understanding psychogenic nonepileptic seizures-Phenomenology, semiology and the Integrative Cognitive Model. Seizure. 2017 Jan;44:199-205.
  5. Plioplys S, Doss J, Siddarth P, Bursch B, Falcone T, Forgey M, Hinman K, LaFrance WC Jr, Laptook R, Shaw RJ, Weisbrot DM, Willis MD, Caplan R. Risk factors for comorbid psychopathology in youth with psychogenic nonepileptic seizures. Seizure. 2016 May;38:32-7.
  6. Say GN, Taşdemir HA, İnce H. Semiological and psychiatric characteristics of children with psychogenic nonepileptic seizures: Gender-related differences. Seizure. 2015 Sep;31:144-8.