nonepileptic

Nonepileptic describes events that resemble epileptic seizures but are not caused by abnormal brain electrical activity. The term encompasses psychogenic nonepileptic seizures (PNES) and other nonepileptic paroxysmal events. Nonepileptic events can occur at any age, with PNES most common in adolescents and young adults, especially women.

Diagnosis relies on neurological assessment and specialized testing to distinguish epileptic from nonepileptic events. Video-EEG monitoring is the gold standard: a PNES seizure occurs with non-epileptiform EEG. Normal EEGs between events do not rule out epilepsy, and PNES is often misdiagnosed as epilepsy, leading to unnecessary antiseizure medications.

Causes and pathophysiology: Nonepileptic seizures most often fall within functional neurological disorders. Psychological factors such as stress or trauma, or psychiatric comorbidity, may contribute, but PNES is not intentional deception. Brain networks involved in emotion regulation and attention are thought to be dysregulated.

Management: A multidisciplinary approach is recommended. Key elements include clear communication of the diagnosis, safety planning, and reducing unnecessary antiseizure drugs. Treatments with evidence include psychotherapy, notably cognitive-behavioral therapy, physical therapy, and addressing comorbid anxiety, depression, or PTSD. Prognosis varies.

Terminology: PNES is preferred by many clinicians; broader terms include psychogenic nonepileptic seizures or functional seizures. Nonepileptic can describe other non-epileptic events such as dissociative spells.