What is the main obstacle in the treatment of psychogenic nonepileptic seizures (PNES)?

Updated: Jul 26, 2018
  • Author: Selim R Benbadis, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

The main obstacle to effective treatment is effective delivery of the diagnosis. The physician delivering the diagnosis must be compassionate, remembering that most patients are not faking, but also firm and confident to avoid the use of ambiguous and confusing terms. Most patients with psychogenic symptoms have previously received a diagnosis of organic disease (e.g., epilepsy); therefore, patients' reactions typically include disbelief and denial, as well as anger and hostility. For example, they may ask "Are you accusing me of faking?" or "Are you saying that I am crazy?"

Patients who accept their diagnosis and follow through with therapy are more likely to experience a successful outcome; therefore, patient education is crucial.


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