Management of psychogenic nonepileptic seizures (PNES): a multidisciplinary approach.

BACKGROUND: The International League Against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic nonepileptic seizures (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized, and management might differ according to the age groups. OBJECTIVE: To reach an expert and stakeholder consensus on PNES management. METHODS: 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"; "pharmacological treatment". After a systematic review of the literature, the board met in a Consensus Conference in Catanzaro (Italy). Further consultations using the model of Delphi panel were held. RESULTS: 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. Seizures' induction was considered ethical, preferring the least invasive techniques. The board recommended: to carefully look for mood disturbances, personality disorders and psychic trauma in persons with PNES; to consider cognitive-behavioural therapy as first line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression. CONCLUSIONS: PNES management should be multidisciplinary. High-quality, long-term studies are needed to standardize PNES management. This article is protected by copyright. All rights reserved.