Of course, more work is needed to help educate our clinicians, our fellow physicians and clinicians, to encourage best practices. We can educate them about the importance of helping clinicians, patients, and family members to realize that psychogenic non-epileptic seizures are real seizures, they’re just not caused by abnormal brain cell discharges. So sometimes patients experience a sense of stigma, not only from society, but also from physicians, and that occurs when physicians and clinicians are dismissive of people with the diagnosis, when they might have kind of a judgmental attitude toward the individual when it’s assumed that the patient is “faking the diagnosis...
Of course, more work is needed to help educate our clinicians, our fellow physicians and clinicians, to encourage best practices. We can educate them about the importance of helping clinicians, patients, and family members to realize that psychogenic non-epileptic seizures are real seizures, they’re just not caused by abnormal brain cell discharges. So sometimes patients experience a sense of stigma, not only from society, but also from physicians, and that occurs when physicians and clinicians are dismissive of people with the diagnosis, when they might have kind of a judgmental attitude toward the individual when it’s assumed that the patient is “faking the diagnosis.”
Whereas, psychogenic non-epileptic seizures, also called functional seizures, it’s a conversion disorder so it’s an unconscious process. I think educating our fellow clinicians to let them know this is a real disorder, it’s an unconscious process, and that we can actually help our patients by making the proper diagnosis using best practices. The International League Against Epilepsy has laid out some of those tools and techniques describing the use of video EEG, or if you don’t have video EEG there are other mechanisms that can be used, so education is one area.
Another area is coming up with approaches that do not compromise ethical interactions with our patients, and so we take a pretty emphatic stance that there’s no room for deceiving our patients. The physician/patient relationship is so, so important and making sure that they have a place where they can trust the clinician is so essential to that physician/patient relationship. I would say we could find better ways to encourage that trust. We could do better with disclosure by letting people know that some procedures can induce epileptic seizures and some can actually induce psychogenic non-epileptic seizures. We might not know the mechanism for how they induce the psychogenic non-epileptic seizures but we do know that we do see that, and just being open and honest in disclosing that in the informed consent might be another way to standardize the approach.
I think it’s good that we’re having the discussion. Many of us thought, well, this debate was settled years ago. You can’t use provocative procedures, but I think that that actually came from a paper and a position that when looking at the literature… An author did a Hastings Center report in 1997 and the question there was, provoking non-epileptic seizures and the ethics of deceptive diagnostic testing. What they did is they actually conflated provocation procedures with deception, and so in this discussion what we’re doing is we’re separating out that you can still provoke a seizure even using a provoking procedure. You can still provoke non-epileptic seizures using a provoking procedure but it doesn’t have to be deceptive so those don’t have to be linked together. I think that way we can really look out for the ethics of the patient, and that includes making sure that we’re watching out for beneficence and autonomy, and that we’re looking out for justice and non-maleficence. We’re doing that for the best care of our patients.