When the diagnosis of nonepileptic seizures (NESs) is confirmed, it must be presented in a positive, supportive, and nonthreatening manner. The physician must have an empathetic, compassionate attitude to ensure the patient's allegiance and offer hope for the future.
NESs should be described as a disorder that cannot be treated with anticonvulsant medication. Emphasize the disability associated with NESs and discuss the effect of the attacks on the patient's life. Also stress that NESs have psychosocial consequences as profound as those of epilepsy but point out that they do not require chronic treatment with drugs that produce side effects.
Outline the availability and indeed the success of treatment for NESs. Explain that many others suffer from NESs but that each person is unique, requiring tailor-made treatment. Reassure the patient that the outlook for improvement or complete recovery is excellent-even better than in the case of epilepsy.
Such a conference is time-consuming but rewarding. Most patients are willing to accept a diagnosis of NESs if it is presented in this manner, and they are eager to pursue an appropriate course of therapy.
Reviewed and revised February 2004 by Orrin Devinsky, MD, New York University
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