Talk:Psychogenic non-epileptic seizure

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Psychogenic seizures not psychogenic?

I removed the assertion that psychogenic seizures are not psychogenic. This article is about psychogenic seizures. Other sorts of seizures, non-psychogenic in origin, are detailed in articles listed under 'see also'. Repeatedly explaining, in an article called "psychogenic seizures," that psychogenic seizures are not psychogenic is confusing and ultimately pointless. This would be similar to repeated assertions in the article entitled Dog, that dogs are not in fact dogs but are cats.

If someone wants to create a section entitled "Controversy," with text along the lines of "Some authorities have stated that psychogenic seizures do not exist per se," that might be a good idea. It would need, however, to be cited, as with any other contribution to Wikipedia, because Wikipedia forbids original research. I am eager, of course, to learn of the existence of any such verifiable statements, and strongly suggest that if they exist they be placed into the article.

-ikkyu2 (talk) 23:13, 12 April 2006 (UTC)[reply]

In my opinion the person who wrote the current article on Psychogenic Non-Epileptic Seizures has an "agenda". The article is clearly imbalanced and attempts to whitewash issues of psychiatric predisposition as well as issues of malingering (wherein "seizures" are used to motivate some form of social gain such as may occur when "seizures" are attributed to an auto or industrial accident potentially tied to financial incentive). Whoever wrote the article probably has some form of practice wherein he/she manages these patients. In practice an accurate diagnosis of psychogenic seizures, malingering, or frank fraud are anathema because they generate patient hostility, billing problems, and possibly even retribution law suits. However, even though rigorous avoidance of accuracy may understandable in some contexts, this is no place to do such a dance. The article needs to be written by someone who is willing to look at the complex issues accurately and without a hidden agenda.


The introductory sentence "There is no scientific consensus as to what causes PNES. However, many physicians believe the condition may be triggered by psychological problems..." seems problematic because PNES is by definition psychological in origin. Gomer2 (talk) 11:34, 31 May 2018 (UTC)[reply]

Gomer2, I just saw your comment. Yes, there is indeed a problem here, in that the name "psychogenic nonepileptic seizures" implies a known causation, but in reality, the causes of PNES are still a matter of debate. But the solution to this problem is not to assert that the causation mentioned in the name must be correct by definition. The solution is to change the name. There is an increasing trend in the literature to refer to these seizures using more neutral terms, such as :non-epileptic attack disorder" or "functional nonepileptic seizures".

I think we are getting to the point where we need to consider changing the title of this page to reflect these recent changes (while still ensuring that searches for PNES redirect here).Wilshica (talk) 01:10, 14 June 2021 (UTC) Wilshica[reply]

Flashlight seizures

Photosensitive epilepsy are of an epilepic origin ,and shouldt be a part of this article The Procrastinator 21:57, 29 December 2005 (UTC)[reply]

I think what you meant to say is that photosensitive epilepsy is non-epileptic in origin and should be a part of this article. Both assertions are wrong. -Ikkyu2 02:47, 30 December 2005 (UTC)[reply]

Why is 'seizures' plural in the article name?

The article discusses a syndrome of recurrent seizures which has no better singular name. An isolated psychogenic seizure does not qualify as conversion disorder, does not require treatment, and in general is different than the syndrome which is discussed in the article. Refer to [1] for more. -Ikkyu2 23:42, 20 January 2006 (UTC)[reply]

Revert to recent edit.

A recent edit included the following text, which I've reverted. Discussion follows:

In the past the patient with psychogenic non-epileptic seizures was thought to have a history of childhood physical abuse or sexual abuse or other severe emotional trauma. Treatment, with cognitive therapy or behavioral therapy, would be focused on strategies to recognize the onset of the seizures and use techniques to abort them, or to interrupt the stimulus-response pathway that produces them.

This is now largely discredited with only a few Psychiatrists willing to pursue this line. These tend to be non-organic such as the leading exponent Douglas Turkington who has led research into the abuse causes of seizures. Turkington holds that even though the patient and their family may not remember the abuse this is because the abuse is repressed (see Freud and the unconscious). As no empirical proof can be provided for this theory other specialists regard such theories as pseudo-science.

This is even more true given the fact that most epilepsy specialists recognise that a) some seizures, especially complex frontal lobe, are very hard to diagnose b) respone to medication is no indication of the pseudo nature of the seizure as patients diagnosed with epilepsy frequently do not respond to treatment.

  • "In the past, the patient with PNES was thought to have a history of childhood physical or sexual abuse." That's not what this paragraph, which I wrote, originally said. It said that such patients were often found to give such a history. That's still true, and I've reverted it to say "sometimes found to give such a history." Mangling text - sourced text, no less - to distort its meaning and then rebutting it is poor editing form, and I request that you not do so in the future.
  • According to Betts, 1997, in EPILEPSY: A COMPREHENSIVE TEXTBOOK, (see article for reference) cognitive behavioral therapy is still the mainstay of treatment technique. If you are going to cite a different theory, such as Mr Turkington's, please provide a verifiable reference published by a reputable source.
  • The paragraph about frontal lobe seizures is not relevant to an article section about the treatment of non-epileptic seizures. Non-epileptic seizures are not caused by epilepsy. If you wish to assert, in an article called 'Psychogenic non-epileptic seizures,' that non-epileptic seizures are caused by epilepsy, I suggest creating a section called 'Criticism' or 'Controversy' and placing your assertions there. If the assertions are not verifiably referenced, they will be removed.

ikkyu2 (talk) 19:43, 16 February 2006 (UTC)[reply]

Also, honestly, I can't understand how editors to this page can use the term pseudoseizures, right after the introduction to the article asserts that that term should never be used. I encourage people thinking of editing the article to read it first. If you're going to write paragraphs about pseudoseizures, at least delete the part where the article admonishes readers never to use the term. ikkyu2 (talk) 03:37, 17 February 2006 (UTC)[reply]

Names

Non-epileptic Attack Disorder

I've created Non-epileptic attack disorder (NEAD) as a redirect to this excellent article. It appears that there is a US/UK split on terminology here, possibly resulting from the influence of Dr Tim Betts (former editor of the journal Seizure and advisor to Epilepsy Action). The two big UK charities have articles referring to NEAD rather than PNES (Epilepsy Action, The National Society for Epilepsy). Searches for NEAD on PubMed tend to show UK research.

I wonder if it we should mention "Non-epileptic Attack Disorder (NEAD)" in the article - otherwise folk may wonder if it is a different thing. I do think there is a subtle difference between NEAD and PNES. NEAD, in using the term "Disorder" appears to be more like a diagnosis/disease. Whereas PNES is a label for symptoms or the manifestation of a disease. (Apologies if I'm not using the precise medical terms here).

Ikkyu2 - The NSE online article mentioned above is written by Tim Betts, who is also the author of one of your references. I can't read the book. However, reading the online article I suspect the article and the chapter have much in common. If you agree, I suggest this article be added to either the External Links or perhaps in the References as an option for those unable to consult the book.

I agree without any reservation. -ikkyu2 (talk) 21:22, 1 March 2006 (UTC)[reply]

Non-epileptic seizures

Non-epileptic seizures is currently a redirect to this article. There is much confusion online as to whether NES is exactly equivalent to PNES. Many NES articles appear to be discussing only psychological causes. Some online articles discussing NES split them into physiological causes and psychogenic causes. I guess the former group get less written attention and are less likely to be given the label "NES" for any length of time, since the patient is then quickly then diagnosed with (and treated for) their physiological condition. I suspect most NES articles are written by folk who are only interested in the PNES aspect.

The book "Differential Diagnosis in Adult Neuropsychological Assessment" (ISBN 0826116655) has a section headed "Non-Epileptic Seizures" on p109. This says "Non-epileptic seizures are seizures that do not original from a primary neurological cause in the brain. The two types of non-epileptic seizures are physiological and psychogenic. Physiological non-epileptic seizures are caused by medical conditions in an organ system other than the brain, such as cardiovascular abnormalities, most commonly syncope. ...". I can't read any of the book "Non-Epileptic Seizures, 2nd edition" (ISBN 0750670266), but from its contents listing it does not appear to discuss physiological conditions.

I wonder if it would be good to promote non-epileptic seizures to being an article of its own. The contents of the "Other non-epileptic seizures" section could go there, as could some of the similar material in the "Diagnosis" section of the epilepsy article. Both this article and the epilepsy article could then have a "See also" to NES. The DAB link at the top of seizure could then point at Non-epileptic seizures.

An even more radical thought would be to move seizure to epileptic seizure and make seizure into a DAB article. I would vote for that since I think it is best to be specific in the name of the article.

I agree; I think all 3 of these articles should at least link to each other in their See also sections. -ikkyu2 (talk) 21:22, 1 March 2006 (UTC)[reply]
With regard to the idea of promoting non-epileptic seizures to its own article, I think that the things that are non-epileptic seizures divide into two categories: psychogenic seizures, and misdiagnosis. People can shake during a syncopal attack, but that doesn't make it a seizure; it makes it a syncope that can be misdiagnosed as a seizure. People can lose the thread of conversation during a migraine aura, but that doesn't make it a non-epileptic complex partial seizure; it's still a migraine headache. People can shake all over due to non-epileptic myoclonus, but what's the point of calling that a seizure? It's myoclonus. These things are not seizures, unless you want to warp the word seizure to mean something that no one expects it to mean, and I don't think that's a particularly good idea. -ikkyu2 (talk) 01:58, 3 March 2006 (UTC)[reply]
I agree with what you've said, from a precise and medical point-of-view. Can I just check – do you no longer think it is useful to create such an article? I still think it is possible to have a Non-epileptic seizures article that carefully discusses the two causes (physiological and psychogenic) and does indeed mention that (after investigation and diagnosis) the former would then be no longer called a seizure by a physician, but he/she would then use the more accurate term appropriate for the actual underlying disease.
However, I think the public use the term seizure in a more general sense than a careful physician would. In the medical world, with the need not to cause any confusion, the term has become exclusively associated with epileptic seizures. Some non-medical dictionary definitions are (excluding the act of taking something):
  • A sudden attack (as of disease) <an epileptic seizure> – Webster's
  • A very sudden attack of an illness involving unconsciousness or violent movement – Cambridge Advanced Learner's Dictionary
  • OLD USE a sudden failure of the heart – Cambridge Advanced Learner's Dictionary
  • A seizure is also the sudden loss of control of your muscles and, often, the loss of consciousness, caused by certain medical conditions – Cambridge Dictionary of American English
  • a sudden manifestation or recurrence of a disease, such as an epileptic convulsion – Collins
  • a sudden attack of illness, especially a stroke or an epileptic fit. – Compact Oxford English Dictionary
  • A sudden attack, spasm, or convulsion, as in epilepsy or another disorder – The American Heritage Dictionary of the English Language
  • The meaning "sudden attack of illness" is attested from 1779 – Online Etymological Dictionary
In my research for List of people believed to have epilepsy, I have read many news stories where the words seizure or fit are used very casually. Any article should be clear on the medical profession's use of the term seizure. At the same time, we must accept that people will call all sorts of things a seizure. --Colin 13:58, 3 March 2006 (UTC)[reply]
I think I'm handicapped by my POV on this one. I've studied this for so many years, and I'm so convinced I'm right :) , that it's hard for me to know exactly what the more typical encyclopedia reader would find useful. -ikkyu2 (talk) 00:30, 7 March 2006 (UTC)[reply]

Pseudoseizures

Whilst I agree the term pseudoseizures is unsatisfactory, we have perhaps yet to find the ideal term. See PMID 14630495 for a study from the patient's point of view. The following statistics are also interesting:

  • non-epileptic attack disorder - 19 PubMed Articles, 281 Google results
  • psychogenic non-epileptic seizures - 25 PubMed Articles, 477 Google results
  • non-epileptic seizures - 92 PubMed Articles, 16,300 Google results, this recent book on Amazon: ISBN 0750670266
  • pseudoseizures - 233 PubMed Articles, 25,100 Google results, this recent book on Amazon: ISBN 1904424279

The term pseudoseizures still appears in recent articles and books - it is not going away quickly --Colin 17:58, 17 February 2006 (UTC)[reply]

Well, it redirects here (to PNES) in both singular and plural forms, and it's bolded in the introduction. It's deprecated for good reasons - it's stigmatizing and strictly inaccurate. I would say that it is going away about as quickly as the term 'epileptic idiot' went away in terms of describing the developmentally delayed person with epilepsy, which is to say, no conceivable speed could be fast enough. -ikkyu2 (talk) 21:22, 1 March 2006 (UTC)[reply]

This isn't just my own personal POV, by the way; although it happens to be, it is also clearly explained, in exactly the way it's explained here in the linked article from the Epilepsy Foundation on PNES. -ikkyu2 (talk) 02:00, 3 March 2006 (UTC)[reply]

I often find it a shame that valid scientific names are deprecated because they may "connote" something in the uneducated eye of the beholder. There are many medical and scientific terms in pseudo- and people should be educated to understand what it means. Dadge (talk) 11:07, 14 August 2015 (UTC)[reply]

what can cause them?

In the paragraph "Causes", there is the sentence "A history of abuse or other psychological trauma is often present as a causative factor", and then a request for citation needed. I would propose the following article as a well done study in reputable medical journal: Nonepileptic seizures and childhood sexual and physical abuse. Kenneth Alper, Orrin Devinsky, Kenneth Perrine, Blanca Vazquez, Daniel Luciano. Neurology, 1993, 43(10). Pubmed ID: 8413951 https://doi.org/10.1212/WNL.43.10.1950 — Preceding unsigned comment added by 70.20.25.26 (talk) 13:22, 30 September 2018 (UTC)[reply]

i was wondering what sort of things can cause seizures? i read party pills can as can low blood sugars but i was wondring about like alchohol and thing like that???? (203.109.241.127 03:48, 25 March 2006 (UTC))[reply]

This isn't the relevent article to answer your question. Have a look at Epilepsy:Causes, though that doesn't really cover one-off seizures. Seizures can be provoked by taking certain drugs and alcohol (and also during withdrawal). Colin°Talk 10:08, 25 March 2006 (UTC)[reply]

Removed unsupported assertion

I removed the following text from the article:

Treatment based on insight-oriented techniques or exploring of abuse histories has not been found to be effective.... Instead, treatment with cognitive therapy or behavioral therapy is focused on concrete strategies to recognize the triggers of the seizures and use techniques to control them and eventually halt the onset.

Those statements are not supported by the references provided. None of the references provided even mentions non-epileptic seizures or their treatment.

There appears to be very little evidence regarding effective treatment for this condition. I did find one study, here, which supports CBT. But I'm not sure that one study warrants inclusion in the encyclopedia.Twerges (talk) 08:12, 9 March 2009 (UTC)[reply]

Removal of unsupported claims in Treatment section

There was some question about my edit here. Another editor claimed on my user page that:

[The edit] removed information that was referenced properly.

The claims were not referenced properly. The claims are followed by references which do not support the claims at all.

For example, take the reference from the mayo clinic website. It says this about treatment:

Seeing a psychologist or professional counselor can help treat symptoms of conversion disorder and prevent it from coming back. This can be especially helpful if you have anxiety, a mood disorder such as depression or other mental health issues.

That does not support the superiority of CBT over insight therapy for this condition. In fact, it does not even mention either CBT or insight therapy.

The other references are even less related to the claims. Most of the references either do not mention CBT or do not mention PNES. One of the references is a general criticism of psychotherapy research and has nothing to do with this topic. Another reference has a malformed URL and goes nowhere.

The only reference which has any support at all for the claims made was here. However, that reference only includes support in the "user comments" section at the bottom of the article, in which anonymous users wrote comments like "CBT worked for me" and so on. That is not an acceptable reference for the claims made, since user comments are not reliable according to WP:RS.

When I did a quick search of pubmed, I found little support for the claims which I deleted. I found exactly one study which supported CBT for this condition: PMID 18395473. That study does not compare the effectiveness of CBT versus insight therapy for this condition. Twerges (talk) 19:28, 5 April 2009 (UTC)[reply]

Thank you for the clarification. I confess I did not go to the original soruces to verify that they stated what they were being used to support. My oversight, sorry and thanks. --PaulWicks (talk) 19:38, 5 April 2009 (UTC)[reply]

Overhauling the article

I am attempting to upgrade this article from a slightly woolly hodgepodge of polemics to a decent article. I'm currently integrating a lot of content from Dr Mellor's recent review and will go out and find some more recent references to weave in once I'm done. All assistance gratefully received! Cheers, --PaulWicks (talk) 20:24, 5 April 2009 (UTC)[reply]

Merger proposal

The article Hystero-epilepsy is somewhat unclear, but looks to me to be suggesting that an anecdote about Charcot is worth an entire encyclopedia article. I disagree and suggest we mention "Hystero-epilepsy" as an outdated term for PNES in the article here and delete the Hystero-epilepsy article. Whaddya reckon? --PaulWicks (talk) 21:21, 5 April 2009 (UTC)[reply]

Yes, I concur. That article is a stub, and has been for quite a while. It's unlikely it will ever be developed further. Merging is a good plan. --Jack-A-Roe (talk) 21:33, 5 April 2009 (UTC)[reply]
Only if you can find a reliable source that says Hystero-epilepsy was actually a form of psychogenic non-epileptic seizures. It looks that way, and a peculiar one at that -- where the patients presented having nothing resembling epilepsy but were placed in a ward with "similar" patients who displayed "epileptic" attacks and they then hysterically "caught" epilepsy from them. If you do merge, it needs to have its own section and made quite clear that this was an invented disease and a product of the hospital care these women received. PNES is not an invented disease. Colin°Talk 22:04, 5 April 2009 (UTC)[reply]
Colin, I think those are fair suggestions and align with what I had in mind. I will await a few more comments before taking action (or not), maybe later this week. --PaulWicks (talk) 07:51, 6 April 2009 (UTC)[reply]

The hystero-epsily section really needs to be removed outright. It's irrelevant to the actual topic at hand, and makes the article confusing to read. Anyone disagree? 50.135.73.142 (talk) 02:09, 21 June 2012 (UTC)[reply]

Hi there, I'd say it can probably be trimmed but retained. I will take a scalpel to it and see what we think. --PaulWicks (talk) 08:53, 21 June 2012 (UTC)[reply]
Looks much better to me. Thanks for the edit. 50.135.73.142 (talk) 05:34, 23 June 2012 (UTC)[reply]

Factitious Seizures?

I query whether the author may have gotten his or her wires crossed in the "Distinguishing Features" section. The diagnostic criteria for NEAD are stated earlier in the article as including an absence of malingering - why, then, does the author use the work 'faking' in the final line of this section?

"Mellors et al. warn that such tests are neither conclusive nor impossible for a determined patient with factitious disorder to "pass" through faking convincingly." — Preceding unsigned comment added by 138.253.244.181 (talk) 09:16, 27 September 2011 (UTC)[reply]

Trying to introduce a note of caution and balance

Hi all,

This page is looking quite good, but I did notice some rather bold claims e.g. PNES are caused by childhood trauma and repressed memories. They could well be, but many would disagree. That's just one hypothesis.

It would be nice to raise the evidential standards on this page a little, if not to the level of mainstream medical pages, at least a bit higher. I've made a few attempts, but would welcome feedback and further contributions. Things I found concerning (you might spot others): 

- there is no scientific consensus as to what causes PNES. We have various theories - all quite different - but they are no more than that. In some places, theory was presented as fact, and this is a bad look.

- there is some evidence to support a role for past trauma, and some to support a role for personality characteristics. But also plenty of studies that support neither.. Need to show balance here.

- when describing theories that are contentious and widely disputed, the phrasing didn't always make that clear.  e.g., Instead of "PNES are caused by childhood abuse", better to say "One theory is that PNES are caused by childhood abuse" (then give supporting evidence and alternative views)

Further suggestions, feedback welcome. — Preceding unsigned comment added by Wilshica (talk • contribs) 01:35, 20 July 2015 (UTC)[reply]

Wiki Project Med student editor

Hello PNES editors, I am a medical student at Tel Aviv University who was assigned this article as part of a wikimed elective course. This article is currently listed as "start-class" so I intend to contribute new portions (e.g. causes, mechanism, pathophysiology, etc.) in an appropriate format. I am collaborating with a member of the ILEA to facilitate neutral improvements. Please reach out to me with comments/questions/concerns regarding my edits.Gomer2 (talk) 18:59, 28 February 2018 (UTC)[reply]

Added "History & Culture" section. Added "Epidemiology" section. Added "Signs & Symptoms" section. Modified "Treatment" section to include (1) clarify importance of education in treatment and (2) difficulty falling through cracks (between psychiatry and neurology)

Modified "Diagnosis" section: 1. "capturing one or two episodes on both videotape..."; videotape is outdated technology 2. Saying EEG tests have high false-positive rate is inaccurate and has more to do with EEG interpretation. false-negative also occurs but apparently can be identified as such. In any case, conventional EEG is not the most relevant for PNES...sticking instead to long-term video-EEG monitoring. 3. goals (#1-4) of EEG-video monitoring

modified Intro: PNES are by definition psychological.

Added "Causes" section:

Gomer2 (talk) 12:31, 31 May 2018 (UTC)[reply]

Sounds good. And welcome. Doc James (talk · contribs · email) 20:05, 3 June 2018 (UTC)[reply]

Moved here

Unclear if these are used in the article as references? Doc James (talk · contribs · email) 20:05, 3 June 2018 (UTC)[reply]

Wiki Edit Class Project

Hello all,

I am an undergraduate student studying psychology and am in my fourth year. I have been researching PNES for all four years of my undergraduate career and will be making edits to this article under the supervision of my PI and a PhD student. My main goals for this article are to update the citations and ensure the citations come from credible scientific sources, among other things. I am linking my sandbox here: https://en.wikipedia.org/wiki/User:SkyM99/Psychogenic_non-epileptic_seizure for anyone to review who may be concerned/interested in my change ideas. This is obviously a work-in-progress and I am still a student, I believe everyone is still a student in this topic, so bear with me! — Preceding unsigned comment added by SkyM99 (talk • contribs) 19:28, 21 March 2021 (UTC)[reply]

Wilshica (talk) 01:00, 14 June 2021 (UTC)== Risk factors ==[reply]

I think the article would be improved if risk factors were defined more narrowly, in line with the use of the term in epidemiology, to include those factors that have genuine predictive value (that is, are associated with increased probability of receiving the diagnosis relative to someone without that factor). This definition would exclude vague psychological constructs like "symptom focusing" as there is no evidence that measures of this construct (even if they could be agreed upon), have any value as predictors of a PNES diagnosis.

I have attempted a rephrase. Wilshica (talk) 01:00, 14 June 2021 (UTC) wilshica[reply]

Follow-up for ReACT treatment

There has been a follow-up study regarding the ReACT treatment for PNES (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8633863/). Could anybody more versed in this topic than I include this information in the article? — Preceding unsigned comment added by 2003:DC:1F2F:34E8:7422:6787:E37E:F460 (talk) 00:27, 7 January 2022 (UTC)[reply]

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 19 January 2021 and 25 April 2021. Further details are available on the course page. Student editor(s): SkyM99. Peer reviewers: DanielJanko, Chanda10.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 07:25, 17 January 2022 (UTC)[reply]

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