<abstract xmlns="http://www.w3.org/1999/xhtml"><p>Psychogenic Non-Epileptic Seizures (PNES) are defined by their semiological resemblance to Epileptic Seizures (ES), not associated with specific epileptic discharges in an ictal EEG. PNES are, in fact, a feature of an underlying psychiatric disorder even if these patients are currently in the realm of epileptologists and for these reasons there is a large degree of confusion underlying the diagnosis (with an average delay of 3 years) and management of PNES. Documented PNES diagnosis would require the attack captured on video EEG (vEEG), but often it is not possible. The video registration of a seizure seen by an expert would make PNES “probable”. Conversational analysis has been demonstrated to be a very useful tool in the differential diagnosis between PNES and ES with a good rate of reliability. From a psychological point of view, PNES could be the same phenotype of different underlying mechanisms and, also for this reason, should consider these underlying processes and treatment could be sometimes seriously deficient. Many psychological approaches are anecdotally reported, but controlled studies are still lacking, and interventions still rely on clinicians’ experience. Moreover, pharmacological treatment may be recommended in adults or elderly with concomitant anxiety or depression. In conclusion, many symptoms and signs are valid but none is pathognomonic, the symptoms should be reported correctly and psychiatrists should be necessarily involved for the correct diagnosis and management of PNES.</p></abstract>

Psychogenic Non-Epileptic Seizures (PNES) are defined by their semiological resemblance to Epileptic Seizures (ES), not associated with specific epileptic discharges in an ictal EEG. PNES are, in fact, a feature of an underlying psychiatric disorder even if these patients are currently in the realm of epileptologists and for these reasons there is a large degree of confusion underlying the diagnosis (with an average delay of 3 years) and management of PNES. Documented PNES diagnosis would require the attack captured on video EEG (vEEG), but often it is not possible. The video registration of a seizure seen by an expert would make PNES “probable”. Conversational analysis has been demonstrated to be a very useful tool in the differential diagnosis between PNES and ES with a good rate of reliability. From a psychological point of view, PNES could be the same phenotype of different underlying mechanisms and, also for this reason, should consider these underlying processes and treatment could be sometimes seriously deficient. Many psychological approaches are anecdotally reported, but controlled studies are still lacking, and interventions still rely on clinicians’ experience. Moreover, pharmacological treatment may be recommended in adults or elderly with concomitant anxiety or depression. In conclusion, many symptoms and signs are valid but none is pathognomonic, the symptoms should be reported correctly and psychiatrists should be necessarily involved for the correct diagnosis and management of PNES.

A brief update on psychogenic non-epileptic seizures: a challenge to overcome

Journal of Epileptology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

{"article-title":"A brief update on psychogenic non-epileptic seizures: a challenge to overcome"}

Psychogenic Non-Epileptic Seizures (PNES) are defined by their semiological resemblance to Epileptic Seizures (ES), not associated with specific epileptic...

	PNES	ES
Etiology	Psychic	Organic
Interictal EEG	Normal	Normal/with epileptiform abnormalities
Seizure length	Usually > 2 minutes	Usually < 2 minutes
Onset	Often gradual	Usually sudden
	EEG patterns are only in wakefulness	Some patients describe altered sensations for a long time before the episode
		Wakefulness/sleep
Frequency	Variable	Parossistic/in cluster
Triggers (light, noise)	Occasionally	Rarely
Aura	Variable	Variable
Seizures’ place	Mostly at home	Everywhere
Witnesses	Yes	Variable
Seizures’ pattern	Variable	Stereotyped
Rolling motor activity	Common	Very rare
Asyncronous movements of limbs	Common	Rare
Finalized movements	Occasional	Very rare
Rhythmic pelvic movements	Occasional	Rare
Opisthotonus, (“arc de circle”)	Occasional	Very rare
Side to side movements	Common	Rare
Tongue biting (tip)	Occasional	Rare
Tongue biting (sides)	Rare	Common
Prolonged ictal atonia	Occasional	Very rare
Shout	Ictal phase (with dramatic, mystic or obscene content) with crying and sobs Occasional	At the big inning, with grunts, along with clonic movements
Mouth closure in tonic phase	Occasional	Very rare
Eyelid closure	Very common	Rare
Resistance to eyelid opening	Very common	Rare
Babinski sign	Negative	Positive if convulsions are present
Pupil reflex to light stimuli	Maintained	Usually absent
Reactivity while unconscious	Occasional	Very rare
Cianosis	Usually absent	Usually present
Post-ictal confusion	Rare	Common
Seizure induction	Triggering	None
Postictal stupor	Rare	Frequent
Urine or feces loss	Reported (more rarely)	Reported
Postictal amnesia	Variable	Usual
Seizure remembering under hypnosis	Yes	No
Effect of hypnosis	High	Mean
Injuries	Rare	Minor, frequent

A brief update on psychogenic non-epileptic seizures: a challenge to overcome

Article Category: critical-appraisal

Publié en ligne: 31 mars 2020

Pages: 67 - 72

Reçu: 13 janv. 2020

Accepté: 09 mars 2020

DOI: https://doi.org/10.21307/joepi-2020-003

© 2020 Massimiliano Beghi et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Frequency of key symptoms and signs in PNES vs ES