PNES patient response to AEDs ‘does not always provide diagnostic clarity’

A new study has highlighted the potential risks of using responsiveness to antiepileptic drugs (AEDs) as a means of differentiating epilepsy from psychogenic nonepileptic seizures (PNES).

Researchers from the University of Sao Paulo have reviewed the medical records of 102 patients with PNES to assess their responses to AEDs, in order to see how this affected their diagnoses.

Currently, a lack of response to AEDS is considered a red flag, pointing to a diagnosis of PNES. However, many patients who receive drug therapies experience placebo effects, which can skew the evidence.

According to the new research, published in the journal Seizure, 22 of the 47 assessed patients with sole PNES reported complete or partial remission following treatment with AEDs. This resulted in a delay to the correct diagnosis of their conditions of around 10.6 years, compared to only 5.6 years in those who did not respond to AEDs.

The report concluded: “A favourable response to AEDs is likely to be interpreted as supporting a diagnosis of epilepsy … Physicians should bear in mind that patients with PNES may be particularly vulnerable to placebo effects.”

PNES can be difficult to diagnose for doctors and patients alike. These seizures are caused by psychological changes, rather than the irregular brain patterns that prompt epileptic seizures.

Posted by Anne Brown

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