Contributor: Katie Sprinkel, MD
Educational Pearls:
- Psychogenic Non-Epileptic Seizures (PNES) are due to a psychogenic rather than an epileptic cause
- Despite common assumption, PNES are not always volitional
- 20-40% of those with PNES can also have true epileptic seizures 20-40%
- True diagnosis requires a video EEG
- Characteristics of PNES include:
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- Waxing and waning of the seizure intensity
- Eyes clenched shut
- Pelvic thrusting, rolling from side-to-side
- Ability to respond to verbal stimuli during the seizure
- Ability to recall information during the seizure
- Weeping or stuttering
- Guarding the face on passive hand drop
- Characteristics of epileptic seizures:
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- Tongue biting
- Prolonged postictal state
- Incontinence
- Haldol or Zyprexa may be better for PNES and benzodiazepines tend to be better for epileptic seizures
References
Huff JS, Murr N. Psychogenic Nonepileptic Seizures. 2021 Jan 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 28722901.
Asadi-Pooya AA. Psychogenic nonepileptic seizures: a concise review. Neurol Sci. 2017 Jun;38(6):935-940. doi: 10.1007/s10072-017-2887-8. Epub 2017 Mar 8. PMID: 28275874.
Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD