Prolonged exposure therapy for the treatment of patients diagnosed with psychogenic non-epileptic seizures (PNES) and post-traumatic stress disorder (PTSD)

Curled up scared rape victim in empty room

We’d be hard pressed to find a clinician or researcher who doesn’t agree that the proper treatment for a confirmed diagnosis of psychogenic non-epileptic seizures (PNES) or non-epileptic attack disorder (NEAD-as it is called in the UK) is some form of psychotherapy.  Although, we’ve known this for decades, we’re still sorely uncertain as to which psychotherapeutic treatment modalities are not just most effective, but effective at all!

For the last few years, our group at the Northeast Regional Epilepsy Group has been working on advancing our understanding of the intergroup differences that exist under the umbrella term of PNES or NEAD.  One such difference that we have consistently come upon is that many of those with PNES have a traumatic history and a certain percentage carries a second diagnosis of post-traumatic stress disorder (PTSD).

At the Northeast Regional Epilepsy Group, we applied a therapy modality that has a long-standing body of research on specific treatments for PTSD to those with PNES and PTSD. It is called prolonged exposure therapy (PE).  Of course, we made certain modifications for when and if seizures occurred in session or in between sessions.   In a recent article, we reported a series of 16 patients dually diagnosed with PNES and post-traumatic stress disorder (PTSD) who were treated with PE.  We also explained  in the publication how we adjusted the treatment to seizures in the office.

Results: Thirteen of the 16 (81.25%) patients who completed therapy reported no seizures by their final PE session, and the other three reported reduced seizure frequency. Depression and post-traumatic stress disorder symptoms also showed significant improvement from baseline to final session. Follow up in 14 patients revealed that gains made on the final session regarding seizure reductions were maintained.

We concluded that PE for patients dually diagnosed with PNES and PTSD preliminarily appears to be a useful treatment modality.  However, as I have said before many times, no treatment can be applied in a cookie-cutter manner. Each individual is different and will need to be carefully evaluated by a professional to determine if this treatment is right for her/him.  Additionally, we now need further research to confirm these findings and to add to our understanding of who can most be helped by this treatment.

If you are interested in reading the full article:

4 thoughts on “Prolonged exposure therapy for the treatment of patients diagnosed with psychogenic non-epileptic seizures (PNES) and post-traumatic stress disorder (PTSD)”

  1. Dennis M Kennedy

    Dr. Myers, I am registered with the Group and attended the last conference. I have received helpful therapy for PNES and I am also in the VA system and treated for a lower level of PTSD. I believe the VA offers PE and my question is whether just certain practitioners are skilled in dealing with dually diagnosed disorders. I am currently in the care of a psychiatrist and a motion disorder neurologist at NY Columbia Presbyterian.

    Grateful for all you do,

    Dennis Kennedy

    1. Hello Mr. Kennedy, thank you for your message and I apologize for just seeing it now. You are correct, the VA has massively trained its mental health providers in PE for PTSD. Although using PE for PNES is in its incipient stages, there are therapists there using it to treat PNES. I believe, they typically check in with and are supervised by staff from the University of Pennsylvania on what specific modifications are needed to treat someone with PNES and PTSD. Best of luck

  2. This illness is so debilitating. My daughter has been struggling with it for 5 years now and while she’s come a long way, and the seizures are much less frequent, they still pose a life altering wall. I wish there was more understanding of these dissociative responses.
    She describes the beginning of these events like losing her grip in reality. Sounds and conversations become muffled and incomprehensible and her inability to speak or respond precludes a PNES event. In public they ALWAYS land her in the emergency room.
    I wish there was some way to help her.

  3. Barbara Young

    I have a 30 yr old OCD daughter who has suffered W Conversion Disorder/PNES, depression, for 12 yrs. She has a family including a 6 yr old SON w autism. She wants to sleep, rest, & avoids doing anything outside of her home & has gained approx 50+ lbs in the past yr. No counseling presently, has Nashville psychiatrist she sees 3-4 X a yr. Since PNES treatment is beginning to surface more, we are hoping to find a PNES counselor in TN. We live near Chattanooga. Do you know of any specialists in this area? We want to help her & I know this is very real, but not sure how to help. Suggestions?

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