Treatment continuing after a diagnosis may reflect prior exposure as well as the new condition.
What the study found
A US claims study examined more than twenty thousand adults with a new psychogenic nonepileptic seizure diagnosis. Prior benzodiazepine receipt predicted subsequent prescriptions, and many previous recipients continued treatment after diagnosis.
Previous receipt was a major predictor
Among 20,848 adults with a newly recorded PNES diagnosis, 18.1% received a benzodiazepine in the following month. Of those with a prescription in the preceding month, 62.9% continued afterward. A new diagnosis therefore did not necessarily represent a new prescribing decision. Anxiety, other indications and the risk of changing established treatment require individual review; claims alone do not show that the drug was intended to treat PNES.
Limits of interpretation
Claims do not establish actual ingestion, diagnostic certainty or the indication for every prescription. Anxiety, insomnia, coexisting epilepsy and the need to manage prior exposure complicate interpretation.
Implications for case review
Distinguish new initiation from continuation. A postdiagnosis prescription does not independently prove that the clinician intended to treat nonepileptic seizures with a benzodiazepine. For a case opinion, review the preexisting treatment plan, taper considerations and the documented diagnosis rather than inferring purpose from a billing sequence.
Source and related reading
Source: PMC11418548, supplied full-text paper. Findings are paraphrased; forensic implications are an interpretation.
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