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Epilepsy Behav. 2017 Mar;68:78-83. doi: 10.1016/j.yebeh.2016.12.013. Epub 2017 Jan 26.

The approach to patients with psychogenic nonepileptic seizures in epilepsy surgery centers regarding diagnosis, treatment, and education.

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Department of Psychiatry, Clinics Hospital of the Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil. Electronic address:
Department of Neurology, Clinics Hospital, Federal University of Paraná, Curitiba, PR, Brazil; Comprehensive Epilepsy Center, Hospital N S das Graças, Curitiba, PR, Brazil.
Medicine and Health Sciences Post-Graduate Program, São Lucas Hospital, Catholic University (PUCRS) RS, Brazil; Department of Neurology, São Lucas Hospital, Catholic University (PUCRS) RS, Brazil; Epilepsy Surgery Program Service, São Lucas Hospital, Catholic University (PUCRS) RS, Brazil.
Brain Institute - Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.
Department of Psychiatry and Medical Psychology, Faculty of Medicine of São José do Rio Preto, SP, Brazil.
Neurologic Institute, Goiania, GO, Brazil.
Basic Research and Advanced Investigations in Neurology, Clinic Hospital of Porto Alegre, Federal University of Rio Grande do Sul, RS, Brazil.
Applied Neuroscience Center and Epilepsy Center of Santa Catarina (CEPESC), Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
Department of Neurology, Medical School - ABC, Santo André, SP, Brazil.
Department of Neurology, Clinics Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil.
Deparment of Neurology, Hospital de Base, Brasilia, Brazil.
Department of Psychiatry, Rhode Island Hospital, Brown University, Providence, RI, USA; Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA.


Previous studies, using surveys, provided an understanding about how health-care providers address patients with PNES. To date, there is limited information on the management of patients with PNES by tertiary referral centers for epilepsy. In this study, we surveyed 11 Brazilian epilepsy center directors about diagnosis, treatment, education and research on PNES. Respondents reported that patients with PNES represented 10-20% of all adult patients recorded by video-EEG (VEEG). All respondents recognized VEEG as the method to confirm the diagnosis, and 81.8% used this approach for confirmation. Most centers had a standard protocol for diagnosis. None of the centers had a particular protocol to treat PNES, but 90.9% had a uniform treatment approach including therapy and educational measures. Psychotherapy was not easily obtained in nine centers (81.8%). Seven (63.3%) centers reported ongoing research projects with PNES. Five centers referred to an educational PNES program discussing diagnosis, but only one reported an educational program for treatment. This study showed a commitment to PNES diagnosis; however, some gaps remain regarding treatment and training, namely implementing a psychotherapy approach for patients and providing educational curricula for clinicians.


Diagnosis; Education; Nonepileptic seizures; PNES; Research; Treatment

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