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To the Editor:
Benbadis et al.1 report the results of a review of 32 patients diagnosed with psychogenic nonepileptic seizures (PNES) in their EEG–video monitoring unit over a 1-year period. With the criteria of “unequivocal epileptiform discharges, focal or generalized, including sharp waves or spikes, spike-wave complexes, polyspikes or any ictal pattern,” but not “transients that met criteria for benign variants,” the study found only 10% of patients had PNES and epileptiform activity. The authors account for prior over-reporting of PNES and epilepsy by the lack of tightly defined criteria for establishing the diagnosis of epilepsy. I applaud the authors for setting the bar higher for diagnosis of this difficult to assess condition.
The authors’ final statement regarding PNES patients’ noncompliance “with the necessary treatment” leaves an open-ended question. What is the necessary treatment for PNES?
As neurologists, we have done a fine job of classifying and describing PNES phenomenologically,2 but we have failed in providing a treatment for these patients. At best, …
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