PNES Forms of Treatment

Psychogenic Non Epileptic Seizures Information

What forms of treatment are available for PNES?

• It may seem trivial, but the first step towards recovery comes through the conversation the patient has with her/his neurologist, psychologist, or psychiatrist while still in the hospital. It is incredibly important that this conversation include a thorough, clear and warm explanation regarding PNES: what it is, what is known about its origins, how it fits the patient and how it can be treated. Ideally, the patient doesn't leave the hospital without a psychological referral in hand.

• Next, the most successful psychological/psychiatric interventions are those that are integrated within an epilepsy center. In other words, the psychologist or psychiatrist is part of the epilepsy center. In this way, the patient continues to be treated by professionals who are very familiar with the disorder, who are colleagues of the patient's epilepsy specialist, and who will be involved in any medication or treatment changes that take place.

• Until recently there was no treatment designed specifically for PNES, at least in part because there are so many variations in patients who have PNES. For example, people with PNES may also have depression, anxiety, complicated personality structures, may or may not have a past history of trauma, etc, etc.

• Despite this, in the last ten years a few descriptions of short-term one-on-one and group treatment have been developed. These treatments have used various psychological theories, including interpersonal, psychodynamic theory, and cognitive-behavioral techniques, trauma specific treatments (including Prolonged Exposure treatment, Eye Movement Desensitization and Reprocessing, and mindfulness techniques), psychoeducation regarding relaxation and assertiveness skills, wellness psychology (emphasizing healthy diet, exercise, and sleep hygiene) and the use of family therapy in some situations.

• At the Northeast Regional Epilepsy Group, we provide individually tailored psychotherapeutic treatment to patients diagnosed with PNES, depending on results from neuropsychological testing and a clinical interview. For patient who are dually diagnosed with PNES and PTSD, we provide prolonged exposure therapy over the course of 12-15 sessions. Prolonged exposure therapy targets PTSD as well as associated symptoms of depression and anger. If seizures occur during the session, breathing retraining and grounding techniques are taught to the patient and practiced whenever needed.

• Elimination of seizures or significant reduction in numbers has been reported in about a 1/4 to over 1/2 of cases using any of the above-mentioned techniques.

• Also, some exercises of sensory grounding that have been borrowed from treatments for posttraumatic stress disorder appear useful in delaying or stopping attacks that are preceded by an aura.

• Monthly support groups for patients that have completed their treatment can be of tremendous use to track patient's progress while also giving them the opportunity to stay involved in a welcoming community. Checking in with the therapist in this way can prove useful for "fine tuning" in new stressful situations that may come up.