What is the recommended mainstay treatment for psychogenic nonepileptic seizures?

Cognitive Behavioral Therapy (CBT) is recognized as the mainstay treatment for psychogenic nonepileptic seizures (PNES). This therapeutic approach focuses on identifying and changing negative thought patterns and behaviors that can contribute to the occurrence and experience of the seizures.

In patients with PNES, the seizures often arise in response to psychological stressors, emotional conflicts, or trauma rather than from neurological causes. CBT helps patients understand the relationship between their emotions and their symptoms, providing tools to manage stress and improve coping strategies. This evidence-based intervention has been shown to effectively reduce the frequency of seizures and improve the patient’s overall psychological well-being.

Other treatment options, such as behavioral medications or traditional anticonvulsants, are not typically effective for PNES since these seizures do not respond to conventional seizure medications, which are designed for epileptic seizures. Electroconvulsive therapy (ECT), while useful for certain severe psychiatric conditions, does not directly address the psychological mechanisms behind PNES. Therefore, CBT remains the most appropriate and effective treatment option for managing psychogenic nonepileptic seizures.