PNES: A Nonpileptic Epilepsy Case Study
INTRODUCTION
Psychogenic nonepileptic seizures (PNES) represent a universal human condition, and are recognized as a worldwide phenomenon [1], sharing many similarities on patients ' demographics, semiology, and coexisting neurological and psychiatric disorders, despite cultural and economic differences (2). This condition continues to generate interest among epileptologists and psychiatrists.
PNESs have an incidence of 1.4/100,000 people per year, and it is estimated that about 20% of the patients referred to tertiary care epilepsy centers for refractory seizures have this condition (3).
Previous studies, using surveys, provided an understanding about how health-care providers (HCP) from distinct countries, such as USA, Chile, UK, Australia and Brazil address patients with PNES. (5,6,7,8). These series showed differences in the diagnosis and treatment that were deemed to be related mainly to the health-care system and
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There is scarce data with respect to how diagnosis, treatment, education and research has been conducted in tertiary care centers for epilepsy treatment. Tertiary care centers play an important role with respect to neurologists education on PNES, its comorbidities and differential diagnosis.
Providing a comprehensive approach across centers may provide more knowledge about PNES, beyond the current emphasis on psychoeducational measures, and the use of psychoactive drugs and AEDs. In addition, more regional health-care policies are also necessary because of relevant differences in health-care systems and consequently in the HCPs ' attitudes and their difficulties, such as limited access to VEEG and referral to effective psychotherapy for PNES.
Typically, neurologists are the first to encounter, diagnose, and provide initial treatment for patients with NES, and then sometimes refer the patients for treatment in psychiatric settings
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