Nonepileptic seizures are episodes of altered movement or sensation, with no associated ictal abnormal electrical brain discharges. 88% of non-epileptic siezures are psychogenic in nature (PNES), and can be difficult to diagnose, especially in the absence of video-EEG. The average delay in diagnosis is 1-7 years, mostly due to the fact that no single clinical data point is definitely diagnostic. This leads to a larger consumption of healthcare resources and iatrogenic symptoms from AEDs.
Some features that point towards the diagnosis of PNES:
- Seizures related to a specific stimulus, such as sounds, food or body movement. An emotional stressor being a precipitant is not pathognomonic for PNES.
- The character of the convulsive movements is different in PNES. The convulsive activity tends to have the same frequency throughout the seizure, with a varied amplitude, as opposed to a true seizure, where the frequency decreases throughout the seizure with an increase in amplitude.
- Resisting eyelid opening
- Guarding of hand dropping on face
- Visual fixation on a mirror or when moving the head from side to side
Keep in mind that PNES and epilepsy can co-exist in up to 30% of patients.
Bottom Line: If you have a clinical concern about PNES, refer the patient for an outpatient video-EEG/neurology followup.
References
Chen DK and LaFrance WC. Diagnosis and Treatment of Nonepileptic Seizures. Continuum 2016;22(1):116 131
