A standardized diagnostic approach and ongoing feedback improves outcome in psychogenic nonepileptic seizures

•We explored the effect of a standardized delivery of PNES diagnosis and weekly motivational feedback on outcome.•Systematic delivery of PNES diagnosis and an inpatient psychiatric consult led to fewer events and better quality of life.•The addition of ongoing motivational feedback led to improved mood status in a third group of patients at follow-up.•PNES patients receiving treatment as usual did not show any significant benefits in any areas of assessment.

IntroductionPsychogenic nonepileptic seizures (PNES) are episodic alterations in behavior presumed to reflect a physical manifestation of underlying psychological distress. Standardized treatment approaches for PNES care are lacking. We evaluated common approaches to PNES management that do not require significant commitment of time and resources.MethodologyPatients with PNES established with video-EEG monitoring were randomized to one of the following three groups: 1) PNES diagnosis delivered per the discretion of the attending physician with advice to seek mental health assistance in the community (n = 12), 2) scripted PNES diagnosis provided and inpatient psychiatry consult obtained (n = 10), and 3) weekly follow-up phone calls made in addition to scripted diagnosis and inpatient psychiatry consultation (n = 15). Reduction in event frequency measured at 8 weeks following hospital discharge represented the primary outcome variable. Secondary variables analyzed included exploration of change in self-reported mood, quality of life, and healthcare utilization.ResultsNo significant improvements were noted in patients simply given a PNES diagnosis and advised to seek outside care on any measure. In contrast, patients receiving a scripted diagnosis and psychiatric consultation demonstrated decreased PNES frequency accompanied by improved quality of life (QOL). Patients also receiving weekly phone calls not only demonstrated decreased PNES frequency and improvements in QOL but also exhibited improved mood.DiscussionThese findings demonstrate that providing diagnostic information regarding PNES is insufficient by itself to meaningfully affect patient outcome. Structured feedback and psychiatric consultation appeared adequate to significantly reduce PNES frequency and improve aspects of quality of life, while the addition of a weekly phone contact also led to improved mood.