Psychogenic non-epileptic seizures: our video-EEG experience

Area of Science:

• Neurology
• Psychiatry

Background:

• Refractory epilepsy poses diagnostic challenges, often requiring differentiation from psychogenic non-epileptic seizures (PNES).
• Accurate diagnosis of PNES is crucial for appropriate treatment and improved patient outcomes.

Purpose of the Study:

• To determine the prevalence of PNES in patients with refractory seizures.
• To characterize typical PNES semiology using video-electroencephalography (video-EEG) monitoring.
• To describe other PNES parameters, including psychiatric comorbidities and treatment outcomes.

Main Methods:

• Prospective evaluation of 596 patients with pharmacoresistant seizures undergoing continuous video-EEG monitoring.
• Inclusion of suggestive seizure provocation in consenting patients.
• Assessment of seizure semiology, interictal EEG, brain MRI, psychiatric comorbidities, personality profiles, and seizure outcomes.

Main Results:

• PNES were detected in 111 (19.3%) of the 596 patients.
• Typical PNES symptoms included initially closed eyelids, rapid tremor, and asynchronous limb movements.
• Psychiatric comorbidities such as personality disorders (46.8%), anxiety (39.6%), and depression (12.6%) were frequent. Interictal EEG and brain MRI were often abnormal.

Conclusions:

• Video-EEG monitoring with suggestive provocation is valuable for diagnosing PNES.
• Distinctive symptoms differentiate PNES from epileptic seizures.
• Despite frequent psychiatric comorbidities and abnormal EEG/MRI findings, a significant proportion of patients achieved seizure freedom or reduction post-diagnosis.