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Psychogenic Nonepileptic Seizure
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Psychogenic Nonepileptic Seizure
, Psychogenic Seizure, Hysterical Seizure, Pseudoseizure, PNES
See Also
Nonepileptic Seizure
Seizure Disorder
Seizure Causes
Definitions
Psychogenic Nonepileptic Seizure (PNES, Pseudoseizure)
Seizure
-Like Symptoms without abnormal electrical activity
Epidemiology
Incidence
: 1-3 per 100,000
Prevalence
: Up to 33 per 100,000
May account for up to 25% of
Seizure
s at
Epilepsy
centers (ambulatory and inpatient)
Epilepsy
patients may also have Psychogenic Seizures in up to 30% of cases
Females account for at two thirds of Psychogenic Seizure patients
Causes
Anxiety Disorder
Panic Attack
s
Post-Traumatic Stress Disorder
Hypochondriasis
Somatization
Conversion Disorder
Acute stress response
Precautions
Pseudoseizures (or Psychogenic Seizures, PNES) are not
Malingering
Patients having Psychogenic Seizures typically do not know this is happening
PNES diagnosis does not exclude neurologic
Seizure
s
PNES can coexist with
Epilepsy
and neurologic
Seizure
s
Martin (2003) Neurology 61(12): 1791-2 [PubMed]
Signs
Atypical
Seizure
motor activity
Asymmetric arm and leg movement
Often non-focal involving opposite arm and leg (e.g. left arm and right leg activity)
Contrast with
Seizure
s which tend to be focal
Pelvic thrusting
Head turning from side to side
Dystonic
Posture
Eyes closed and resists
Eyelid
movement
Tongue
biting limited to tip of
Tongue
Avoidance during
Seizure
Atypical
Seizure
timing
Gradual onset and last 2-3 minutes (contrast with 1 minute for typical
Seizure
)
Waxing and waing course (contrast with rhythmic periodicity of
Seizure
)
Recur frequently
Typically lacks the postictal period of
Seizure Disorder
Other factors
Resistance to multiple antiepileptic agents
Emotional or situational triggers
Postictal crying
May remember episode (contrast with
Seizure
where there is no memory of the episode)
Differential Diagnosis
See
Nonepileptic Seizure
Movement Disorder
(e.g.
Tic Disorder
,
Extrapyramidal Side Effect
)
Atypical epileptic
Seizure
s
Frontal Lobe
Seizure
Atypical motor and verbal activity
Often occur during sleep and brief duration
Gelastic
Seizure
(laughs during
Seizure
)
Myoclonic
Seizure
Diagnosis
End-Tidal CO2
Prolonged
Seizure
Oxygen Saturation
falls
End-Tidal CO2
rises
Prolonged Psychogenic Seizure
Oxygen Saturation
remains normal
End-Tidal CO2
remains normal
Diagnosis
Inpatient Video EEG
Typical
Seizure
as confirmed by witnesses of
Seizure
No corresponding EEG abnormalities
Interrater reliability of EEG monitoring is poor
Benbadis (2009) Neurology 73(11):843-6 [PubMed]
Diagnosis
Clinical findings that do not identify
Seizure Disorder
Postictal
Serum Prolactin
Tongue
-biting, self-injury or
Incontinence
Psychological Testing
Outpatient
Electroencephalogram
Management
Interdisciplinary approach
Mental Health
Cognitive Behavioral Therapy
may reduce PNES events in the short term
Goldstein (2010) Neurology 74(24): 1986-94 [PubMed]
References
Bright, Shoenberger, Stellpflug in Herbert (2013) EM:Rap 13(3):3-4
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