Psychogenic nonepileptic seizures

Psychogenic nonepileptic seizures are involuntary episodes of sensation, movement, or behavior that may mimic epileptic seizures but do not result from abnormal cortical discharges. The electroneurodiagnostic evaluation for suspected psychogenic nonepileptic seizures presents a confounding and challenging task to the physician/ technologist team. Because the events may closely mimic true epileptic seizures, it is reported that as many as one quarter of patients presenting to epilepsy centers with intractable, medication-refractory seizures are found to have been misdiagnosed as having epilepsy (Alsaadi and Marquez 2005). Treatment regimens that are appropriate for epileptic seizures are inappropriate and ineffectual in the treatment of psychogenic nonepileptic seizures. In the absence of coexisting epilepsy, inappropriate diagnosis and treatment exposes these patients to the adverse effects of antiepileptic drugs, socioeconomic hardships (patients may be unable to work or drive or have limited social activities), and adds to the burden on healthcare resources (Benbadis 2001). Video electroencephalography has become the gold standard in the diagnostic work-up to differentiate between seizures of neurologic origin and the nonepileptic somatic movements, sensations, and behaviors that are manifested by psychosocial distress.