Pseudoseizures and Psychogenic Non-Epileptic Seizures (PNES)

Psychogenic Non-Epileptic Seizures (PNES), also known as pseudoseizures are episodes of movement, sensation, or behaviours that are similar to epileptic seizures but with no neurologic origins. It is considered a form of conversion disorder, as there are somatic manifestations of psychologic distress. Patients with psychogenic nonepileptic seizures frequently are misdiagnosed and treated for epilepsy.

• Seizures and pseudoseizures are not mutually exclusive disorders!
  • Anywhere from 5 to 10% of outpatient epilepsy patients and 20 to 40% of inpatient epilepsy patients have co-occuering psychogenic nonepileptic seizures.

• PNES does not occur during sleep although they may be reported as such.
• The lack of tongue-biting, urinary incontinence, cyanosis, auras, post-ictal confusion, and/or injuries from falls may suggest pseudoseizures.

• Video-electroencephalography monitoring is preferred for diagnosis
• With EEG alone, it may be hard to differentiate pseudoseizures from temporal lobe epilepsy

• The drop-arm test can be helpful as clinical clue^[1]
• In attacks resembling epilepsy or syncope (“psychogenic” non-epileptic attacks), the occurrence of closed eyes with resistance to opening or a normal simultaneous electroencephalogram (although this alone does not exclude all forms of epilepsy or syncope)
• Pupillary​ ​and​ ​gag​ ​reflexes​ ​retained​ ​post​-pseudoseizure

• Nonepileptic behavioral disorders: diagnosis and treatment
• Psychogenic Nonepileptic Seizures. Am Fam Physician. 2005 Sep 1;72(5):849-856.