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Psychogenic nonepileptic seizures (PNES) are paroxysms of altered sensory, cognitive, and/or motor manifestations with or without alteration of consciousness that may resemble epileptic seizures, but do not originate from epileptiform brain activity. One framework conceives PNES as arising from a biopsychosocial, multifactorial etiologic model. An unexpectedly high co-occurrence rate of PNES and mild traumatic brain injury (mTBI) has been reported. A causal relationship may be possible in many cases. In applying the biopsychosocial framework, this review discusses how TBI may subserve contributing roles as Predisposing, Precipitating, and Perpetuating factors in the development of PNES.
Patients with nonepileptic seizures (NES) frequently present in neurology, psychiatry, psychology, and emergency departments. The disorder has been well-documented in the medical literature, and much is known about the phenomenology, ictal semiology, neurologic signs, psychiatric comorbidities, neuropsychological testing, and psychosocial aspects. Since the publication of the third edition in 2010, knowledge of treatments for NES has grown and new data have become available. Fully updated to reflect these developments, this fourth edition brings together the current knowledge of NES treatments, drawing on the experience of an international team of authors. An accompanying website features video-EEGs of seizures and videos of patient-clinician interactions, which will help readers with both diagnostic and management decisions. Tables clearly illustrating the differential diagnosis of various nonepileptic events give readers quick reference guides to aid diagnostic assessment. A valuable resource for neurologists, psychiatrists, psychologists, and any clinicians who encounter NES in their practice.