Psychogenic Nonepileptic Seizures: An Integrative Narrative Review of Diagnostic, Neuropsychological and Therapeutic Aspects

Psychogenic nonepileptic seizures are paroxysmal events that resemble epileptic seizures but occur in the absence of epileptiform activity. They represent a complex and disabling condition at the intersection of neurology, psychiatry, and clinical psychology, frequently encountered in neurological and general medical settings. PNES are associated with long diagnostic delays, inappropriate use of antiseizure medications, and significant psychosocial burden. Methods: A comprehensive search of PubMed, Scopus, and Web of Science databases was conducted for literature published between January 2000 and October 2025. Eligible studies included original research, systematic reviews, and meta-analyses focusing on PNES diagnosis, neuropsychological correlates, and treatment approaches. Study quality was assessed using SANRA criteria, and findings were synthesized within a multidisciplinary framework. Although PRISMA guidelines were considered as a methodological reference, this work was conducted as a narrative review aimed at providing an integrative clinical perspective. Results: Psychogenic nonepileptic seizures are strongly associated with trauma exposure, dissociation, and psychiatric comorbidities. Video-electroencephalography remains the diagnostic gold standard, while structured clinical interviews and neuropsychological assessment improve diagnostic accuracy and treatment planning. Cognitive-behavioral therapy provides the most consistent evidence of efficacy, achieving reduction in seizure frequency in approximately 50–60% of cases, as reported in randomized controlled trials. Complementary approaches include trauma-focused, psychodynamic, and mindfulness-based therapies, with early reports on neurobehavioral therapy. Emerging directions include digital self-monitoring, telehealth, and, in selected comorbid cases, esketamine treatment, although robust controlled trials are lacking. Overall, findings support the value of a multidisciplinary and patient-centered clinical approach. Conclusions: Timely recognition of psychogenic nonepileptic seizures and adoption of integrated, patient-centered models of care are crucial to improving outcomes. Priorities for future research and practice include reducing diagnostic delays, enhancing clinician education, and developing scalable, trauma-informed therapeutic pathways applicable to routine clinical settings.