Differentiating psychogenic nonepileptic from epileptic seizures: A mixed-methods, content analysis study.

Area of Science:

• Neurology
• Psychiatry
• Linguistics

Background:

• Differentiating psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES) is crucial for effective diagnosis and management.
• Patient seizure descriptions offer insights into distinguishing features between PNES and ES.

Purpose of the Study:

• To compare verbal seizure descriptions from patients with PNES and ES using a mixed-methods approach.
• To identify clinical features that may help distinguish PNES from ES.

Main Methods:

• Semi-structured interviews were conducted with patients diagnosed with video-electroencephalography (EEG)-confirmed ES (n=30) or PNES (n=10).
• Transcripts were coded for psychological categories and discrepancies; Linguistic Inquiry and Word Count (LIWC) system was utilized.
• Descriptive and inferential analyses compared phenomena frequencies, with logistic regression examining predictive diagnostic power.

Main Results:

• PNES descriptions included longer seizures, preseizure negative emotions, anxiety, altered senses, and dissociative phenomena.
• Epileptic seizures (ES) descriptions featured more self-injurious behavior, while postictal amnesia and aches were more common in ES.
• Predictive power of combined features reached 97.5%, though no single variable was significant; linguistic differences in pronoun use and family references were noted.

Conclusions:

• No single feature definitively distinguishes PNES from ES, but several suggest PNES: longer duration, pervasive fear, preseizure anxiety, ictal dissociation, and postseizure weeping.
• Fewer reports of ictal self-injury and postseizure amnesia/aches may also suggest PNES.
• Combined clinical features provide high diagnostic accuracy for distinguishing PNES from ES.