Psychogenic Nonepileptic Seizures Medication

  • Author: Selim R Benbadis, MD; Chief Editor: Helmi L Lutsep, MD  more...
Updated: Aug 04, 2016

Medication Summary

A pilot study in 2010 suggested serotonin selective reuptake inhibitors (SSRIs) may be helpful in reducing seizures in PNES.[15] In a 2013 study, researchers conducted a single-center, double-blind, pilot randomized controlled clinical trial that compared the effects of sertraline and placebo on nonepileptic seizure rates in adults diagnosed with PNES.[21] Of the 128 patients eligible for the study, 38 were randomized to either sertraline or placebo titration group. Dosage in the sertraline group started at 25 mg daily and increased to 50 mg at two weeks and kept increasing further in 50 mg increments to a maximum of 200 mg daily, as tolerated. Frequency of nonepileptic seizures was assessed every 2 weeks for 12 weeks. Seizure frequency at 12 weeks did not differ between the sertraline and placebo groups (relative risk [RR], 0.51; 95% confidence interval [CI], 0.25–1.05; P =0.29). Within-group analysis, which compared the 12-week and baseline event rates, revealed significant reductioninthe sertraline group (RR, 0.55; 95% CI, 0.32–0.93; P =0.03); but not in the placebo group (8% increase; P =0.78).[21]

Contributor Information and Disclosures

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cyberonics; Eisai; Lundbeck; Sunovion; UCB; Upsher-Smith<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cyberonics (Livanova); Eisai; Lundbeck; Sunovion; UCB<br/>Received research grant from: Cyberonics (Livanova); GW, Lundbeck; Sunovion; UCB; Upsher-Smith.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jose E Cavazos, MD, PhD, FAAN, FANA, FACNS Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, Assistant Dean for the MD/PhD Program, Program Director of the Clinical Neurophysiology Fellowship, University of Texas School of Medicine at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center, University Hospital System; Director, San Antonio Veterans Affairs Epilepsy Center of Excellence and Neurodiagnostic Centers, Audie L Murphy Veterans Affairs Medical Center

Jose E Cavazos, MD, PhD, FAAN, FANA, FACNS is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Neurological Association, Society for Neuroscience, American Epilepsy Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Brain Sentinel, consultant.<br/>Stakeholder (<5%), Co-founder for: Brain Sentinel.

Chief Editor

Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.

Additional Contributors

Raj D Sheth, MD Chief, Division of Pediatric Neurology, Nemours Children's Clinic; Professor of Neurology, Mayo College of Medicine; Professor of Pediatrics, University of Florida College of Medicine

Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, Child Neurology Society

Disclosure: Nothing to disclose.

  1. LaFrance WC, Benbadis SR. Avoiding the costs of unrecognized psychological nonepileptic seizures. Neurology. 2006 Jun 13. 66(11):1620-1. [Medline].

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

  3. Benbadis SR, Tatum WO. Overintepretation of EEGs and misdiagnosis of epilepsy. J Clin Neurophysiol. 2003 Feb. 20(1):42-4. [Medline].

  4. Benbadis SR, Lin K. Errors in EEG interpretation and misdiagnosis of epilepsy. Which EEG patterns are overread?. Eur Neurol. 2008. 59(5):267-71. [Medline].

  5. Benbadis SR. Errors in EEGs and the misdiagnosis of epilepsy: importance, causes, consequences, and proposed remedies. Epilepsy Behav. 2007 Nov. 11(3):257-62. [Medline].

  6. Syed TU, Lafrance WC Jr, Kahriman ES, et al. Can semiology predict psychogenic nonepileptic seizures? a prospective study. Ann Neurol. 2011 Jun. 69(6):997-1004. [Medline].

  7. Benbadis SR. A spell in the epilepsy clinic and a history of "chronic pain" or "fibromyalgia" independently predict a diagnosis of psychogenic seizures. Epilepsy Behav. 2005 Mar. 6(2):264-5. [Medline].

  8. Elzawahry H, Do CS, Lin K, Benbadis SR. The diagnostic utility of the ictal cry. Epilepsy Behav. 2010 Jun 1. [Medline].

  9. Benbadis SR, LaFrance WC Jr, Papandonatos GD, Korabathina K, Lin K, Kraemer HC. Interrater reliability of EEG-video monitoring. Neurology. 2009 Sep 15. 73(11):843-6. [Medline]. [Full Text].

  10. Hubsch C, Baumann C, Hingray C, Gospodaru N, Vignal JP, Vespignani H, et al. Clinical classification of psychogenic non-epileptic seizures based on video-EEG analysis and automatic clustering. J Neurol Neurosurg Psychiatry. 2011 Sep. 82(9):955-60. [Medline].

  11. Benbadis SR, O'Neill E, Tatum WO, Heriaud L. Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center. Epilepsia. 2004 Sep. 45(9):1150-3. [Medline].

  12. Benbadis SR. Mental heath organizations and the ostrich policy. Neuropsychiatry. 2013. 1:5-7.

  13. Goldstein LH, Chalder T, Chigwedere C, Khondoker MR, Moriarty J, Toone BK, et al. Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology. 2010 Jun 15. 74(24):1986-94. [Medline]. [Full Text].

  14. Harden CL, Burgut FT, Kanner AM. The diagnostic significance of video-EEG monitoring findings on pseudoseizure patients differs between neurologists and psychiatrists. Epilepsia. 2003 Mar. 44(3):453-6. [Medline].

  15. LaFrance WC Jr, Keitner GI, Papandonatos GD, et al. Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizures. Neurology. 2010 Sep 28. 75(13):1166-73. [Medline]. [Full Text].

  16. Benbadis SR. Psychogenic non-epileptic seizures. Wyllie E, Gupta A, Lachhwani DK, eds. The Treatment of Epilepsy: Principles and Practice. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2005. 623-30.

  17. Benbadis SR. The problem of psychogenic symptoms: is the psychiatric community in denial?. Epilepsy Behav. 2005 Feb. 6(1):9-14. [Medline].

  18. Ameri8can Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.

  19. Mellers JD. The approach to patients with "non-epileptic seizures". Postgrad Med J. 2005 Aug. 81(958):498-504. [Medline]. [Full Text].

  20. LaFrance WC Jr, Baker GA, Duncan R, Goldstein LH, Reuber M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia. 2013 Nov. 54(11):2005-18. [Medline].

  21. Bravo TP, Hoffman-Snyder CR, Wellik KE, Martin KA, Hoerth MT, Demaerschalk BM, et al. The effect of selective serotonin reuptake inhibitors on the frequency of psychogenic nonepileptic seizures: a critically appraised topic. Neurologist. 2013 Jan. 19(1):30-3. [Medline].

  22. LaFrance WC Jr, Baird GL, Barry JJ, Blum AS, Frank Webb A, Keitner GI, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014 Sep 1. 71(9):997-1005. [Medline].

Psychogenic nonepileptic attacks. The event is provoked by an induction (or provocative) technique. Note the typical irregular nonclonic nontonic and asynchronous movements (including bicycling) with stop-and-go phenomenon.
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