Abstract
Psychogenic nonepileptic seizures (PNES) are the most common type of functional neurological
symptom disorders and are frequently diagnosed in tertiary care epilepsy monitoring
units. These are associated with significant decline in social functioning and quality
of life. The majority of patients with PNES are women, outnumbering men by a ratio
of 3:1. Female sex preponderance occurs after puberty and usually before the age of
55 years. Many of the psychiatric risk factors in PNES (depression, anxiety, history
of traumatic experiences, other somatic symptom disorders) are more common in women
and may partially account for the difference in sex prevalence. Neurobiological and
neurohumoral mechanisms may also play a role, but our understanding is limited at
this point. In this review, we present information on epidemiology and risk factors,
neurobiological and psychological mechanisms, clinical approach to diagnosis, evidence-based
treatment, and long-term outcomes. We highlight findings related to differences between
women and men in PNES. Most of these data are not decisive and require further corroboration.
While the disorder may be more frequently suspected in women, all patients with suspected
PNES deserve an objective and thorough investigation of their symptoms. Early and
accurate identification of this disorder should be a priority, especially as evidence-based
treatments, which may lead to improved outcomes, are increasingly available.
Keywords
psychogenic nonepileptic seizures - functional neurological disorder - female - women
- risk factors - diagnosis - evidence-based treatment - sex differences
