The International League against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic non-epileptic seizure (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized and management might differ according to age group. The objective was to reach an expert and stakeholder consensus on PNES management. A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients’ representatives was formed. The board chose five main topics regarding PNES: diagnosis; ethical issues; psychiatric comorbidities; psychological treatment; and pharmacological treatment. After a systematic review of the literature, the board met in a consensus conference in Catanzaro (Italy). Further consultations using a model of Delphi panel were held. The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizure induction was considered ethical, preferring the least invasive techniques. The board recommended looking carefully for mood disturbances, personality disorders and psychic trauma in persons with PNES and considering cognitive-behavioural therapy as a first-line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression. Psychogenic non-epileptic seizure management should be multidisciplinary. High-quality long-term studies are needed to standardize PNES management.

Management of psychogenic non-epileptic seizures: a multidisciplinary approach / Gasparini, S; Beghi, E; Ferlazzo, E; Beghi, M; Belcastro, V; Biermann, Kp; Bottini, G; Capovilla, G; Cervellione, Ra; Cianci, V; Coppola, G; Cornaggia, Cm; De Fazio, P; De Masi, S; De Sarro, G; Elia, M; Erba, G; Fusco, L; Gambardella, A; Gentile, V; Giallonardo, At; Guerrini, R; Ingravallo, F; Iudice, A; Labate, A; Lucenteforte, E; Magaudda, A; Mumoli, L; Papagno, C; Pesce, Gb; Pucci, E; Ricci, P; Romeo, A; Quintas, R; Sueri, C; Vitaliti, G; Zoia, R; Aguglia, U.. - In: EUROPEAN JOURNAL OF NEUROLOGY. - ISSN 1351-5101. - 26:2(2019), pp. 205-215. [10.1111/ene.13818]

Management of psychogenic non-epileptic seizures: a multidisciplinary approach

Papagno C;
2019-01-01

Abstract

The International League against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic non-epileptic seizure (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized and management might differ according to age group. The objective was to reach an expert and stakeholder consensus on PNES management. A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients’ representatives was formed. The board chose five main topics regarding PNES: diagnosis; ethical issues; psychiatric comorbidities; psychological treatment; and pharmacological treatment. After a systematic review of the literature, the board met in a consensus conference in Catanzaro (Italy). Further consultations using a model of Delphi panel were held. The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizure induction was considered ethical, preferring the least invasive techniques. The board recommended looking carefully for mood disturbances, personality disorders and psychic trauma in persons with PNES and considering cognitive-behavioural therapy as a first-line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression. Psychogenic non-epileptic seizure management should be multidisciplinary. High-quality long-term studies are needed to standardize PNES management.
2019
2
Gasparini, S; Beghi, E; Ferlazzo, E; Beghi, M; Belcastro, V; Biermann, Kp; Bottini, G; Capovilla, G; Cervellione, Ra; Cianci, V; Coppola, G; Cornaggia, Cm; De Fazio, P; De Masi, S; De Sarro, G; Elia, M; Erba, G; Fusco, L; Gambardella, A; Gentile, V; Giallonardo, At; Guerrini, R; Ingravallo, F; Iudice, A; Labate, A; Lucenteforte, E; Magaudda, A; Mumoli, L; Papagno, C; Pesce, Gb; Pucci, E; Ricci, P; Romeo, A; Quintas, R; Sueri, C; Vitaliti, G; Zoia, R; Aguglia, U.
Management of psychogenic non-epileptic seizures: a multidisciplinary approach / Gasparini, S; Beghi, E; Ferlazzo, E; Beghi, M; Belcastro, V; Biermann, Kp; Bottini, G; Capovilla, G; Cervellione, Ra; Cianci, V; Coppola, G; Cornaggia, Cm; De Fazio, P; De Masi, S; De Sarro, G; Elia, M; Erba, G; Fusco, L; Gambardella, A; Gentile, V; Giallonardo, At; Guerrini, R; Ingravallo, F; Iudice, A; Labate, A; Lucenteforte, E; Magaudda, A; Mumoli, L; Papagno, C; Pesce, Gb; Pucci, E; Ricci, P; Romeo, A; Quintas, R; Sueri, C; Vitaliti, G; Zoia, R; Aguglia, U.. - In: EUROPEAN JOURNAL OF NEUROLOGY. - ISSN 1351-5101. - 26:2(2019), pp. 205-215. [10.1111/ene.13818]
File in questo prodotto:
File Dimensione Formato  
Gasparini et al.pdf

accesso aperto

Tipologia: Pre-print non referato (Non-refereed preprint)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 138.13 kB
Formato Adobe PDF
138.13 kB Adobe PDF Visualizza/Apri
Euro J of Neurology - 2018 - Gasparini - Management of psychogenic non‐epileptic seizures a multidisciplinary approach.pdf

Solo gestori archivio

Tipologia: Versione editoriale (Publisher’s layout)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 421.33 kB
Formato Adobe PDF
421.33 kB Adobe PDF   Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11572/252054
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 68
  • ???jsp.display-item.citation.isi??? 55
social impact