Recent progress in the understanding and treatment of nonepileptic seizures.

Purpose of reviewThere has been a steady increase in the number of publications about (psychogenic) nonepileptic seizures(NES) over the past two decades. This review focuses on work published in the past 3 years. It summarizesthe most important developments in terms of diagnosis, cause, clinical manifestations and treatment of NES.Recent findingsSeveral recent studies demonstrate the scope and limitation of questionnaire-based and conversationanalytic approaches to the differential diagnosis of epilepsy and NES. Experimental work has revealed thatpatients with NES have increased levels of physiological arousal at rest which are associated withabnormal mental processing. There is a growing understanding of the meaning and clinical significance ofthe heterogeneous manifestations of NES. Several studies document the therapeutic potential of an earlyand effective communication of the diagnosis of NES. A number of randomized controlled or uncontrolledlong-term follow-up pilot studies suggest that different forms of psychotherapy are effective for NES.SummaryRecent research has improved our understanding of NES as a biopsychosocial disorder. Clear diagnosticand management pathways for patients with NES are likely to emerge in the near future.Keywordscause, conversion disorder, dissociative disorder, psychogenic nonepileptic seizures, psychotherapy