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