Psychogenic seizures: a focused clinical review for the emergency medicine practitioner

Psychogenic seizures sometimes mimic neurogenic seizures and may occur concomitantly. Unlike neurogenic seizures, psychogenic seizures do not have abnormal electrical discharges on electroencephalogram, and their presence generally reflects an underlying psychiatric disorder. No single clinical observation can definitively distinguish psychogenic from neurogenic seizures. Evidence in support of the diagnosis includes asynchronous extremity movements, rapid turning of the head from side to side, forward pelvic thrusting, out-of-phase limb movements, presence of a light reflex, and geotropic eye movements. Video electroencephalogram monitoring is a particularly valuable method of distinguishing psychogenic from neurogenic seizures. When the diagnosis is suspected by history, physical examination, maneuvers, and laboratory tests, and after the proper stabilization steps have been taken, the emergency medicine practitioner should consult a neurologist and a psychiatrist to assist in the patient's further evaluation and management. Although the diagnosis of psychogenic seizures cannot always be secured in the emergency department, identifying patients with this condition is important because it can obviate unnecessary pharmacologic interventions and help patients obtain proper psychiatric care.