Supplementary Material for: Psychogenic Nonepileptic Seizures in a Woman of Reproductive Age: The Role of Gender-Specific Stressors

Introduction:
Psychogenic nonepileptic seizures (PNES) are episodes resembling epileptic seizures but not caused by abnormal electrical brain activity. They are part of functional neurological disorders (FND), which disproportionately affect women and are often triggered by a combination of biological, psychological, and social factors. Early recognition is crucial to prevent unnecessary interventions.
Case presentation:
We report a 35-year-old woman with a 3-year history of recurrent loss of 8 consciousness, occurring approximately every 15 days, usually coinciding with ovulation and menstruation. Previous cardiology and gynecology evaluations, imaging, blood tests, and EEG were unremarkable. During the most severe episodes, she required ICU admission, intubation, and sedation. A video-EEG with verbal suggestion reproduced a typical event, showing no epileptiform activity. The patient was diagnosed with PNES. Psychotherapy was initiated, and antiepileptic drugs were gradually withdrawn. This, along with patient education, family involvement, and outpatient follow-up, led to a marked reduction in episode frequency. 

Conclusion:
This case highlights the complex interplay between hormonal fluctuations, reproductive concerns, psychosocial stressors, and gender-specific factors in triggering PNES. Early diagnosis, a multidisciplinary approach, and education of patients and healthcare providers are key to improving outcomes and avoiding unnecessary interventions. To our knowledge, this is the first report describing PNES episodes linked to both menstrual cycle–related stress and reproductive concerns, emphasizing the importance of a gender-sensitive approach.