[Phenomenology of motor crisis in non-epileptic patients with psychogenic crises]

Recognition of different ictal motor patterns in psychogenic seizures may be useful in terms of differentiation from epileptic seizures and may also improve understanding the underlying psychopathology.

To outline recognizable ictal motor patterns that may help to distinguish psychogenic motor seizures from epileptic convulsive episodes.

Chart review from 54 patients with motor psychogenic seizures and no clinical or EEG evidence of concomitant epilepsy.

Only 5 patients (9.2%) experienced more than one ictal motor pattern along their illness. Categorization into four subtypes according to ictal motor behaviour was possible in all other patients: psychogenic seizures with flaccid unconsciousness (32.6%), combativeness (32.6%), a hypermobile subtype (24.4%) as defined by the presence of intentional movements or slow rhythmic oscillations of a segment or the entire body, and rigidity (10.2%).

Many psychogenic motor seizures consistently present with recognizable motor phenomena which may be readily identified providing the availability of a reliable witness. Psychogenic seizures as presented spontaneously in a general neurology setting may differ from those reported in biased referrals to video-EEG laboratories. Recognition of characteristic patterns may help differentiation from tonic-clonic convulsions, avoid unnecessary examinations, and may provide insights into their underlying psychopathological mechanisms.