Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: A staged approach

A report from the International League Against Epilepsy Nonepileptic Seizures Task Force

Authors

  • W. Curt LaFrance Jr.,

    Corresponding author
    1. Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, Rhode Island, U.S.A
    2. Departments of Psychiatry and Neurology (Research), Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
    • Address correspondence to W. Curt LaFrance Jr., MD, MPH, Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Brown University, 593 Eddy Street, Providence, RI 02903, U.S.A. E-mail: william_lafrance_jr@brown.edu

    Search for more papers by this author
  • Gus A. Baker,

    1. Walton Centre for Neurology and Neurosurgery, University Department of Neurosciences, University of Liverpool, Liverpool, Merseyside, United Kingdom
    Search for more papers by this author
  • Rod Duncan,

    1. Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
    Search for more papers by this author
  • Laura H. Goldstein,

    1. Department of Psychology, King's College London, Institute of Psychiatry, London, United Kingdom
    Search for more papers by this author
  • Markus Reuber

    1. Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom
    Search for more papers by this author

  • This report was written by experts selected by the International League Against Epilepsy (ILAE) and was approved for publication by the ILAE. Opinions expressed by the authors, however, do not necessarily represent official policy or position of the ILAE.

Summary

An international consensus group of clinician-researchers in epilepsy, neurology, neuropsychology, and neuropsychiatry collaborated with the aim of developing clear guidance on standards for the diagnosis of psychogenic nonepileptic seizures (PNES). Because the gold standard of video electroencephalography (vEEG) is not available worldwide, or for every patient, the group delineated a staged approach to PNES diagnosis. Using a consensus review of the literature, this group evaluated key diagnostic approaches. These included: history, EEG, ambulatory EEG, vEEG/monitoring, neurophysiologic, neurohumoral, neuroimaging, neuropsychological testing, hypnosis, and conversation analysis. Levels of diagnostic certainty were developed including possible, probable, clinically established, and documented diagnosis, based on the availability of history, witnessed event, and investigations, including vEEG. The aim and hope of this report is to provide greater clarity about the process and certainty of the diagnosis of PNES, with the intent to improve the care for people with epilepsy and nonepileptic seizures.

Ancillary