Literature Monitor

Provocative Induction of PNES Doesn’t Require Placebos

Epilepsia; 2018 Nov; Chen et al.


Diagnosing psychogenic nonepileptic seizures (PNES) can prove challenging; using provocative induction is one way to detect the disorder. A recent experiment suggests that inducing seizures without the use of a placebo is just as effective as inducing them with one.

  • Researchers compared 170 patients suspected of having PNES who underwent provocative induction plus placebo to 170 patients who underwent the same induction procedure without a saline solution placebo.
  • Induction triggered a seizure in 79.4% of patients without the help of the placebo, compared to 73.5% with placebo, a non-significant difference.
  • Investigators postulated that the greater success rate in the non-placebo group may have resulted from the greater cumulative induction experience of clinicians, which may have influenced the manner and presentation of how the induction was presented.
  • The study concluded that experienced clinicians should opt for non-placebo based provocative induction.

Chen DK, Dave H, Gadelmola, K et al. Provocative induction of psychogenic nonepileptic seizures: Noninferiority of an induction technique without versus with placebo. Epilepsia. 2018; 59:e161-e165.

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