Myths and truths about pediatric psychogenic nonepileptic seizures

• Type of Material: Article
• Authors: Jung Sook Yeom, Gyeongsang National University; Heather Bernard, Children's Healthcare of Atlanta; Sookyong Koh, Emory University
• Language: English
• Date: 2021-01-01
• Publisher: The Korean Pediatric Society
• Publication Version: Final Published Version
• Copyright Statement: © 2021 by The Korean Pediatric Society
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3345/cep.2020.00892
• Title of Journal or Parent Work: CEP: Clinical and Experimental Pediatrics
• Volume: 64
• Issue: 6
• Start Page: 251
• End Page: 259
• Grant/Funding Information: This work was supported by the Gyeongsang National University Fund for Professors on Sabbatical Leave, 2019.
• Keywords: Dissociative reaction; Somatic symptoms; Nonepileptic seizure; Emotional stress; Neurobiology
• Research Categories: Psychology, Psychobiology; Biology, Neuroscience; Psychology, Clinical; Health Sciences, Human Development

Abstract

Psychogenic nonepileptic seizures (PNES) is a neuropsychiatric condition that causes a transient alteration of consciousness and loss of self-control. PNES, which occur in vulnerable individuals who often have experienced trauma and are precipitated by overwhelming circumstances, are a body’s expression of a distressed mind, a cry for help. PNES are misunderstood, mistreated, under-recognized, and underdiagnosed. The mindbody dichotomy, an artificial divide between physical and mental health and brain disorders into neurology and psychiatry, contributes to undue delays in the diagnosis and treatment of PNES. One of the major barriers in the effective diagnosis and treatment of PNES is the dissonance caused by different illness perceptions between patients and providers. While patients are bewildered by their experiences of disabling attacks beyond their control or comprehension, providers consider PNES trivial because they are not epileptic seizures and are caused by psychological stress. The belief that patients with PNES are feigning or controlling their symptoms leads to negative attitudes of healthcare providers, which in turn lead to a failure to provide the support and respect that patients with PNES so desperately need and deserve. A biopsychosocial perspective and better understanding of the neurobiology of PNESmay help bridge this great divide between brain and behavior and improve our interaction with patients, thereby improving prognosis. Knowledge of dysregulated stress hormones, autonomic nervous systemdysfunction, and altered brain connectivity in PNES will better prepare providers to communicate with patients how intangible emotional stressors could cause tangible involuntary movements and altered awareness.