• Logo
  • SBMUJournals

Psychogenic Non-Epileptic Seizures; a Narrative Review

Ameneh Jafari, Mostafa Rezaei Tavirani, Mohsen Prvareshi Hamrah, Sanaz Ahmadi Karvigh, Haniyeh Bashi Zadeh Fakhar




Psychogenic non-epileptic seizures (PNES) are paroxysmal changes that mimic epileptic seizures, so often misdiagnosed and treated for epilepsy. PNES are considered a psychiatric illness, personality pathology, and experiential and behavioral manifestation of depression. Despite studies over the past two decades, the pathological mechanisms of this disorder are unclear. In this paper, we critically review the current literature about the definition, epidemiology, diagnosis, treatment, related genes, and biomarkers of PNES and provide suggestions for future research. Further studies are needed for more information and knowledge on PNES to determine the appropriate psychotherapies and development of clear treatment guidelines.


Seizures; Epilepsy; Psychogenic; Biomarkers; Conversion disorder


Takasaki, K., A.D. Stransky, and G.J.P.n. Miller, Psychogenic nonepileptic seizures: Diagnosis, management, and bioethics. 2016. 62: p. 3-8.

Wiseman, H. and M.J.S. Reuber, New insights into psychogenic nonepileptic seizures 2011–2014. 2015. 29: p. 69-80.

Baslet, G.J.S., Psychogenic non-epileptic seizures: a model of their pathogenic mechanism. 2011. 20(1): p. 1-13.

Bodde, N.M., et al., Psychogenic non-epileptic seizures—diagnostic issues: a critical review. 2009. 111(1): p. 1-9.

Brown, R.J. and M.J.C.p.r. Reuber, Towards an integrative theory of psychogenic non-epileptic seizures (PNES). 2016. 47: p. 55-70.

Myers, L., et al., Prolonged exposure therapy for the treatment of patients diagnosed with psychogenic non-epileptic seizures (PNES) and post-traumatic stress disorder (PTSD). 2017. 66: p. 86-92.

Sundararajan, T., G. Tesar, and X.J.S. Jimenez, Biomarkers in the diagnosis and study of psychogenic nonepileptic seizures: a systematic review. 2016. 35: p. 11-22.

Witgert, M.E., et al., Frequency of panic symptoms in psychogenic nonepileptic seizures. 2005. 6(2): p. 174-178.

Lacey, C., et al., The neurologist, psychogenic nonepileptic seizures, and borderline personality disorder. 2007. 11(4): p. 492-498.

Alsaadi, T.M. and A.V.J.A.F.P. Marquez, Psychogenic nonepileptic seizures. 2005. 72(5): p. 849-856.

Szaflarski, J.P., et al., Four-year incidence of psychogenic nonepileptic seizures in adults in Hamilton County, OH. 2000. 55(10): p. 1561-1563.

Asadi-Pooya, A.A., M.R.J.E. Sperling, and Behavior, Epidemiology of psychogenic nonepileptic seizures. 2015. 46: p. 60-65.

Fairclough, G., Perspectives on Psychogenic Non-Epileptic Seizures. 2012, The University of Manchester (United Kingdom).

Baird, G.L., Seizure clusters in patients with psychogenic non-epileptic seizures. 2016.

Reuber, M.J.N.c., The etiology of psychogenic non-epileptic seizures: toward a biopsychosocial model. 2009. 27(4): p. 909-924.

Ahmedani, B.K., et al., Diagnosis, costs, and utilization for psychogenic non-epileptic seizures in a US health care setting. 2013. 54(1): p. 28-34.

Cronje, G., C.J.E. Pretorius, and Behavior, The coping styles and health-related quality of life of South African patients with psychogenic nonepileptic seizures. 2013. 29(3): p. 581-584.

Macias, A., PNES: Neuropsychological impairments and psychological symptomatology. 2006: Loma Linda University.

Goldstein, L., J.J.J.o.N. Mellers, Neurosurgery, and Psychiatry, Ictal symptoms of anxiety, avoidance behaviour, and dissociation in patients with dissociative seizures. 2006. 77(5): p. 616-621.

Schwabe, M., et al., Differential diagnosis of seizure disorders: a conversation analytic approach. 2007. 65(4): p. 712-724.

Oto, M., Undiagnosing and untreating psychogenic non epileptic seizures. 2011, University of Glasgow.

Asadi-Pooya, A.A.J.N.S., Psychogenic nonepileptic seizures: a concise review. 2017. 38(6): p. 935-940.

Collins, W., O. Lanigan, and N. Callaghan, Plasma prolactin concentrations following epileptic and pseudoseizures. Journal of Neurology, Neurosurgery & Psychiatry, 1983. 46(6): p. 505-508.

Shukla, G., et al., Serum prolactin levels for differentiation of nonepileptic versus true seizures: limited utility. Epilepsy & Behavior, 2004. 5(4): p. 517-521.

Fisher, R.S., et al., Capillary prolactin measurement for diagnosis of seizures. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 1991. 29(2): p. 187-190.

Zhang, S.-W. and Y.-X.J.N.b. Liu, Changes of serum adrenocorticotropic hormone and cortisol levels during sleep seizures. 2008. 24(2): p. 84-88.

Maguire, J. and J.A. Salpekar, Stress, seizures, and hypothalamic–pituitary–adrenal axis targets for the treatment of epilepsy. Epilepsy & Behavior, 2013. 26(3): p. 352-362.

Rao, M.L., H. Stefan, and J. Bauer, Epileptic but not psychogenic seizures are accompanied by simultaneous elevation of serum pituitary hormones and cortisol levels. Neuroendocrinology, 1989. 49(1): p. 33-39.

Bakvis, P., et al., Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures. 2010. 51(5): p. 752-759.

Pritchard III, P.B., et al., Serum prolactin and cortisol levels in evaluation of pseudoepileptic seizures. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 1985. 18(1): p. 87-89.

Willert, C., et al., Serum neuron‐specific enolase, prolactin, and creatine kinase after epileptic and psychogenic non‐epileptic seizures. 2004. 109(5): p. 318-323.

Petramfar, P., et al., Serum creatine phosphokinase is helpful in distinguishing generalized tonic–clonic seizures from psychogenic nonepileptic seizures and vasovagal syncope. 2009. 15(3): p. 330-332.

Holtkamp, M., et al., Diagnosis of psychogenic nonepileptic status epilepticus in the emergency setting. 2006. 66(11): p. 1727-1729.

Javali, M., et al., Role of biomarkers in differentiating new-onset seizures from psychogenic nonepileptic seizures. 2017. 8(4): p. 581.

Numakawa, T., et al., BDNF function and intracellular signaling in neurons. Histology and histopathology, 2010.

Bengzon, J., et al., Regulation of neurotrophin and traka, trkb and trkc tyrosine kinase receptor messenger RNA expression in kindling. Neuroscience, 1993. 53(2): p. 433-446.

Aydin, S., et al., Time-dependent changes in the serum levels of prolactin, nesfatin-1 and ghrelin as a marker of epileptic attacks young male patients. 2011. 32(6): p. 1276-1280.

Numakawa, T., et al., BDNF function and intracellular signaling in neurons. 2010.

Deveci, A., et al., Serum brain‐derived neurotrophic factor levels in conversion disorder: Comparative study with depression. 2007. 61(5): p. 571-573.

LaFrance, W., et al., Decreased serum BDNF levels in patients with epileptic and psychogenic nonepileptic seizures. 2010. 75(14): p. 1285-1291.

Winterdahl, M., et al., Vulnerability to psychogenic non-epileptic seizures is linked to low neuropeptide Y levels. 2017. 20(6): p. 589-597.

Thomas, G.G., E.J.A.r.o.n. Lena, and n.t.f.c. practice, Chronic stress and the hpa axis: clinical assessment and therapeutic considerations. 2010. 9.

Heim, C., et al., Lower CSF oxytocin concentrations in women with a history of childhood abuse. 2009. 14(10): p. 954.

Hertting, A., T.J.P. Theorell, and Psychosomatics, Physiological changes associated with downsizing of personnel and reorganisation in the health care sector. 2002. 71(2): p. 117-122.

Morales-Medina, J.C., Y. Dumont, and R.J.B.r. Quirion, A possible role of neuropeptide Y in depression and stress. 2010. 1314: p. 194-205.

Nishikimi, T., K. Kuwahara, and K.J.J.o.c. Nakao, Current biochemistry, molecular biology, and clinical relevance of natriuretic peptides. 2011. 57(2): p. 131-140.

Komarek, M., et al., Vascular effects of natriuretic peptides in healthy men. 2004. 9(4): p. 263-270.

Ceylan, M., et al., Serum NT-pro CNP levels in epileptic seizure, psychogenic non-epileptic seizure, and healthy subjects. 2018. 39(12): p. 2135-2139.

Baslet, G., et al., Heterogeneity in psychogenic nonepileptic seizures: understanding the role of psychiatric and neurological factors. 2010. 17(2): p. 236-241.

Thompson, R., et al., What is it like to receive a diagnosis of nonepileptic seizures? 2009. 14(3): p. 508-515.

Baslet, G., et al., Treatment of psychogenic nonepileptic seizures: updated review and findings from a mindfulness-based intervention case series. 2015. 46(1): p. 54-64.

Goldstein, L., et al., Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. 2010. 74(24): p. 1986-1994.

LaFrance Jr, W.C., et al., Cognitive behavioral therapy for psychogenic nonepileptic seizures. 2009. 14(4): p. 591-596.

DOI: https://doi.org/10.22037/aaem.v8i1.552

DOI (PDF): https://doi.org/10.22037/aaem.v8i1.552.g703