Psychogenic nonepileptic seizures (PNES) Pseudo-seizures

Psychogenic nonepileptic seizures (PNES) is the most prevalent type of functional neurological disorder (FND), affecting 2-33 individuals per 100,000 population. Onset of PNES typically occurs during teen years or young adulthood, with higher rates observed in women compared to men.

These events “consist of paroxysmal alterations in motor, sensory, autonomic, or cognitive functions that are not associated with ictal epileptiform activity (EEG activity).

Individuals with PNES are often misdiagnosed with epilepsy and may not receive an accurate diagnosis for many years. Among patients referred to tertiary epilepsy centers with refractory seizures, an estimated 10%-40% of cases are ultimately diagnosed as PNES.

Although PNES symptoms may be difficult to distinguish from those of epilepsy on observation alone, some of the clinical features that have been more frequently noted in PNES vs epileptic seizures include rapid recovery as well as “longer duration, fluctuating course, asynchronous movements, pelvic thrusting, side-to-side head or body movement, persistently closed eyes and mouth, ictal crying, recall of ictal experiences and absence of postictal confusion

Nonetheless, it is important for clinicians to avoid making assumptions that patients with PNES are feigning their symptoms. “The common mistake doctors make is assuming that patients are malingering and stopping the anti-epileptic can trigger status epilepticus

The only way to prove or disprove PNES is by capturing the events on [video-electroencephalogram] VEEG, the gold standard in diagnosing PNES. These days, with smart camera phones, it is easier to get those videos at home and show it to the treating doctor.

PNES is highly prevalent, resembling ES on many levels and poses significant problems for physicians. PNES can be carefully differentiated from ES with respect to its demographics, prodromal symptoms, onset, ictal duration, semiology of the seizure and its associated symptoms, and associated psychiatric disorders. Efforts to integrate the current wealth of evidence and using a more structured and combined diagnostic approach should be done in order to increase the accuracy of PNES diagnosis.

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