Orbitofrontal cortex dysfunction in psychogenic non-epileptic seizures. A proposal for a two-factor model

Psychogenic nonepileptic seizures (PNES) often mimic epileptic seizures and occur in both people with and without epilepsy. Pathophysiology of conversion disorders such as PNES remains unclear though significant psychological, psychiatric and environmental factors have been correlated with a diagnosis of PNES. Many clinical signs that have been considered typical for PNES can also be found in frontal epileptic seizures. Given the resemblance of seizures and affective changes from Orbitofrontal cortical dysfunction to PNES like events and correlation of psychological and environmental stress to conversion disorders such as PNES, we propose a two-factor model for the pathogenesis of PNES. We hypothesize that patients with PNES could have a higher likelihood of having both Orbitofrontal cortical dysfunction and a history of psychological stressors rather than a higher likelihood of having either one or the other. We further explore the implications of this two-factor model, including possible therapies.