Non Epileptic Events

Psychogenic nonepileptic seizures have long been known by many names. A short list includes hysteroepilepsy, hysterical seizures, pseudoseizures, nonepileptic events, nonepileptic spells, nonepileptic seizures, and psychogenic nonepileptic attacks.

These events are typically misdiagnosed for years and are frequently treated as electrographic seizures and epilepsy. These patients experience all the side effects of antiepileptic drugs and none of the benefits. PNES are clinical attacks that may mimic epileptic seizures but seem to reflect psychological issues. The term “pseudoseizures” is now considered inappropriate and should be avoided. Psychiatric comorbidities that are frequently associated include depression and other mood disorders, posttraumatic stress disorder, anxiety, and somatoform and dissociative disorder. A history of sexual or physical abuse or childhood neglect and PTSD may be part of the history.

PNES is diagnosed in 20%-30% of those admitted for the evaluation of apparently medically refractory seizures. Estimates of the frequency of concomitant epilepsy in people with PNES vary from 10% to 50%.

PNES are often associated with several clinical manifestations that change from seizure to seizure. Seemingly convulsive seizures are associated with body thrashing, flopping, flailing, pelvic thrusting, tremors varying in amplitude and frequency, and side-to-side head shaking. Tongue biting may occur, usually involving the tip of the tongue, rather than the side of the tongue as seen in GTC seizures. Movements involving the extremity are often asynchronous and erratic. Eye closure during a seizure is considered a highly dependable indicator for identifying

PNES. PNES are typically prolonged, and motor symptoms typically wax and wane with alternating periods of motor agitation and quiescence. Postictal breathing patterns may also help differentiate PNES from GTC epileptic seizures. Irregular, shallow, and quiet breathing patterns are present in convulsive PNES, whereas regular, deep, and loud breathing, often accompanied with snoring, usually follows GTC epileptic seizures.

PNES is not associated with ictal electrographic correlates. EEG artifacts time-locked to movements during convulsive PNES do not evolve in frequency.

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