What is “treatment as usual” for nonepileptic seizures?

ObjectiveA recent NINDS/NIMH/AES-sponsored international NES Treatment Workshop identified a lack of knowledge in the field regarding standard of care in the management of patients with psychological nonepileptic seizures (NES).MethodsWe administered a survey to AES clinicians to determine actual postdiagnostic instructions given to patients and referral practices, or NES treatment as usual.ResultsThe majority of respondents were epileptologists, followed by neurologists, neuropsychologists, and nurses, evenly dispersed across the United States. Almost all respondents reported discussing the diagnosis of NES with the patients. Sixty-nine percent of neurologists continued to follow the patient after NES diagnosis. Treatment referrals were most commonly made to psychiatrists and psychologists. Antiepileptic drugs were tapered by 83% of the respondents, and 47% prescribed psychotropic medications if comorbid diagnoses were made.ConclusionThis is the first known national survey that summarizes national practices and the range of care, or treatment as usual, offered to patients with NES.