Neuroimaging of Psychogenic Nonepileptic Seizures

Although as many as one in five patients presenting to neurologists with blackouts or seizures has Psychogenic Nonepileptic Seizures (PNES, also labelled dissociative or functional seizures), and despite the fact that PNES disorders cluster into a discrete number of stereotyped sets of experiences and behaviours, our understanding of the pathophysiology is still limited. Whereas there is a long tradition of research focusing on “why” PNES may develop relatively little research has examined “how” they unfold in the brain. My talk will explore how neuroimaging studies have helped us to conceptualise PNES as a network disorder. While discussing the limitations of the research carried out so far, I will describe the potential of neuroimaging as a diagnostic tool, as a method to explore the heterogeneity of PNES disorders and as an approach to developing new treatments. I conclude that neuroimaging has demonstrated its potential to help with the understanding of PNES but that larger studies with better patient characterisation are needed to make sense of what continues to be a challenging disorder to study.