How do you counsel patients on anti-seizure medication necessity (or lack thereof) in the setting of PNES without comorbid epilepsy?
Occasionally, patients referred for dedicated epilepsy management for "medication refractory epilepsy" are found to have purely non-epileptic spells. In those cases where the diagnosis of epilepsy is properly excluded, part of the management is to taper off any ASMs/AEDs that do not serve some other medical or psychiatric purpose (mood stabilization, migraine prophylaxis, etc.). What techniques have you found effective for persuading patients who are either fearful of, or outright opposed to, a medication wean?
Answer from: at Academic Institution
I discuss in detail and openly with the patients regarding the etiology of epileptic seizures in comparison with the current understanding of etiology in PNES and help them understand why traditional anticonvulsants won't work for PNES. I also explain that taking a medication that may not be indicat...
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Answer from: at Academic Institution
"If they don't need it, stop it".
Once the diagnosis of PNES has been established, I have an extended conversation with the patient/caregivers/family regarding basic concepts of seizures and epilepsy, and why the current testing does not support such a diagnosis. This is followed by an explanation ...