pnes icd 10

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20-03-2025

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PNES: A Comprehensive Overview of Psychogenic Non-Epileptic Seizures (ICD-10 G90.2)

Psychogenic Non-Epileptic Seizures (PNES), classified under ICD-10 code G90.2, are a complex neurological condition characterized by episodes resembling epileptic seizures but lacking the characteristic electrical abnormalities in the brain seen in epileptic seizures. Unlike epileptic seizures, which originate from abnormal electrical activity in the brain, PNES are thought to originate from a dysfunction in the brain's processing of emotional and psychological distress. This crucial distinction highlights the need for accurate diagnosis and appropriate treatment strategies, which often require a multidisciplinary approach. This article will delve into the various aspects of PNES, encompassing its diagnostic criteria, underlying mechanisms, associated factors, treatment options, and the importance of collaborative care.

Understanding the Diagnostic Criteria of PNES (ICD-10 G90.2)

The diagnosis of PNES is primarily based on clinical observation and exclusion of epileptic seizures. The ICD-10 classification, G90.2, groups PNES under "other disorders of movement." While there isn't a universally accepted single diagnostic criterion, clinicians rely on several key factors:

• Video-EEG Monitoring: This is considered the gold standard for diagnosing PNES. Simultaneous video recording of the seizure and electroencephalography (EEG) allows clinicians to observe the clinical features of the episode and simultaneously assess for any epileptic abnormalities in brainwave activity. The absence of epileptiform discharges during a clinically suggestive seizure strongly supports a diagnosis of PNES.

• Clinical Features: PNES often exhibit atypical seizure characteristics, differing from typical epileptic seizures. These features can include:

  • Variability in seizure semiology: The presentation of PNES can vary significantly from one episode to another, unlike epileptic seizures, which tend to have a more consistent pattern.
  • Prolonged seizure duration: PNES episodes are often longer than typical epileptic seizures.
  • Presence of subtle or unusual motor movements: These movements may not conform to the typical clonic or tonic patterns seen in epileptic seizures.
  • Response to suggestion or distraction: In some cases, the seizure may be influenced by suggestion or distraction, a feature rarely seen in epileptic seizures.
  • Absence of postictal confusion or neurological deficits: Following a PNES episode, patients typically return to their baseline level of consciousness and neurological function without any lingering impairment, unlike post-ictal states often observed after epileptic seizures.

• Exclusion of Epilepsy: Thorough neurological examination and investigations, including EEG and potentially MRI, are crucial to rule out epilepsy. This is because some patients may experience both epileptic and psychogenic seizures (comorbidity).

• Psychological Evaluation: A psychological assessment is often necessary to evaluate for underlying psychological distress, trauma, or other mental health conditions that may contribute to the development of PNES.

Underlying Mechanisms and Associated Factors of PNES

The exact mechanisms underlying PNES are still not fully understood, but it is widely believed that these seizures represent a complex interplay of psychological and neurological factors. Several theories attempt to explain their pathogenesis:

• Somatization: PNES may represent a physical manifestation of underlying psychological distress, where emotional or psychological conflicts are expressed through physical symptoms.

• Neurobiological Dysfunction: Research suggests that dysfunction within the brain's limbic system and other areas involved in emotional processing may play a role. These areas may be excessively sensitive to stress or emotional triggers.

• Learned Behavior: Some research indicates that PNES may be influenced by learned behaviors, where the seizures may be inadvertently reinforced through attention or secondary gain.

• Trauma and Abuse: A significant number of individuals with PNES have experienced childhood trauma, abuse, or other adverse life events. These experiences can contribute to the development of psychogenic symptoms.

• Pre-existing psychiatric conditions: Comorbidity with anxiety, depression, post-traumatic stress disorder (PTSD), and other psychiatric conditions is frequently observed.

Treatment Strategies for PNES: A Multidisciplinary Approach

Treatment of PNES requires a multidisciplinary approach, involving neurologists, psychiatrists, psychologists, and other healthcare professionals as needed. Effective treatment typically focuses on several key areas:

• Psychotherapy: This is usually the cornerstone of PNES treatment. Cognitive behavioral therapy (CBT), psychodynamic therapy, and trauma-focused therapies are often employed to address underlying psychological factors, manage stress, and develop coping mechanisms.

• Psychiatric Medication: In cases where significant comorbid psychiatric conditions such as depression or anxiety are present, medication may be necessary to alleviate these symptoms. Antidepressants, anxiolytics, or other psychotropic medications may be prescribed under the guidance of a psychiatrist.

• Education and Support: Providing education about PNES to the patient and their family is crucial for improving understanding, reducing stigma, and fostering a supportive environment.

• Physical Therapy: In some cases, physical therapy may be beneficial to address any physical limitations or motor dysfunction related to the seizures.

• Neurology Consultation: Regular neurological consultations are essential to monitor seizure frequency and progression, rule out any co-occurring epilepsy, and adjust treatment plans as needed.

Importance of Collaborative Care and Long-Term Management

Effective management of PNES requires a collaborative approach involving healthcare professionals and the patient. Open communication, shared decision-making, and regular monitoring are crucial for successful treatment. Long-term management may involve ongoing psychotherapy, medication management, and regular follow-up appointments. The ultimate goal is to improve the patient's quality of life by reducing seizure frequency, addressing underlying psychological factors, and providing ongoing support.

Prognosis and Challenges in Managing PNES

The prognosis of PNES is variable and depends on several factors, including the severity of the condition, the presence of comorbid conditions, and the patient's response to treatment. While some patients may experience complete remission, others may have persistent seizures despite treatment. A significant challenge in managing PNES lies in the difficulty of accurately diagnosing the condition and addressing the complex interplay of psychological and neurological factors involved. The stigma associated with PNES also presents a significant barrier to seeking help and adhering to treatment.

Conclusion:

PNES (ICD-10 G90.2) is a complex neurological condition requiring a thorough diagnostic process and a multidisciplinary treatment strategy. Accurate diagnosis through video-EEG monitoring and a comprehensive clinical evaluation is crucial for differentiating PNES from epileptic seizures. Treatment focuses on addressing underlying psychological factors, managing comorbid conditions, and providing education and support to patients and their families. Collaborative care and long-term management are essential for improving the quality of life of individuals with PNES. Further research is needed to enhance our understanding of the underlying mechanisms of PNES and develop more effective treatment approaches.