Response to the letter regarding the impact of psychogenic nonepileptic seizures and our seizure assessment tool

I have reviewed the letter by Dr Villano and colleagues and appreciate the importance of distinguishing psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES). As they adequately state, the incidence of PNES in patients with brain tumors is unknown. However, the incidence of seizures in brain tumor patients is well known and has been described.¹ Due to the high incidence of seizures in this population, ES are the primary concern. It is possible that some patients may harbor PNES and ES from tumor-associated epilepsy. Distinguishing these conditions would require video EEG and intensive monitoring of their habitual events, neither of which is feasible for routine use in our population. However, in the appropriate clinical situation, intensive video monitoring should be pursued to distinguish these 2 entities.

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