Long-term video EEG monitoring for diagnosis of psychogenic nonepileptic seizures

Figures & data

Table 1 Differences in semiology and timing between PNES and epileptic seizures

	PNES	Epileptic seizure
Timing
Directly induced by stress or confrontation	++	+
Waxes and wanes	++	-
Occurs in physician office	++	-
Worsens with witnesses in the room	++	-
Semiology
Crying	+	-
Whispering	+	-
Stuttering	+	-
Opisthotonic posture	+	-
Full body shaking with preserved awareness	++	-
Ictal cry	-	++ (before GTC seizure)
Post-ictal buzz saw snore	-	++ (after GTC seizure)
Eyes closed	++	-
Head/body/eye version	-	++ (focal seizure)
Fencer’s posture	-	++ (focal seizure)
Side-to-side head movement	+	-
Pelvic thrusting	+	+
Cyanosis	-	+ (during GTC seizure)
Severe injury or trauma (burns and fractures)	-	+ (during GTC seizure)

Notes: ++ represents “frequent”, + represents “occasional”, and - represents “absent.”

Abbreviations: PNES, psychogenic nonepileptic seizures; GTC, generalized tonic-clonic.

Figure 1 The PT transitions into a typical PNES.

Notes: Immediately prior to it, the EEG background shows a normal waking rhythm. The EEG is then obscured by movement and muscle artifact that is most prominent in the posterior regions.
Abbreviations: PT, patient; PNES, psychogenic nonepileptic seizure; EEG, electroencephalogram.

Figure 2 The patient is in the middle of a typical PNES.

Notes: The EEG background is obscured by movement and muscle artifact that is most prominent in the posterior regions. There is an embedded 1-second period when the movement stops and normal background is seen before the background is again obscured by movement and muscle artifact.
Abbreviations: PNES, psychogenic nonepileptic seizure; EEG, electroencephalogram.

Figure 3 The patient transitions out of a typical PNES.

Notes: Initially, the slide shows EEG background obscured by movement and muscle artifact that is most prominent in the posterior regions. Immediately after it, the EEG background returns to a normal waking background.
Abbreviations: PNES, psychogenic nonepileptic seizure; EEG, electroencephalogram.