Pseudoseizures AKA PNES

By Christie Lech, MD

Please refer to EMRAP

  • PNES – psychogenic nonepileptic seizures
  • Pseudoseizure – non-epileptic seizure
  • PNES is characterized by neurological disturbances i.e. motor, sensory, autonomic, cognitive, emotional that may mimic epilepsy, but there is no CNS dysfunction
  • Incidence is 1 to 3 per 100,000, prevalence 2-33 per 100,000 – both are probably underestimates
  • There is also a subset of patients with PNES and epilepsy – prevalence is 5-56%
  • No race, marital status, or education correlation associated with this diagnosis
  • Often with an epileptic episode there will be some focality to it, and there will be some type of rhythm or cadence to the movement.
  • In a non-epileptic episode there is more of a waxing and waning of movement and there is no focality
  • The incidence of tongue biting, unresponsiveness, self-injury, and incontinence is more common with epilepsy, but both can happen in pseudoseizures as well
  • If the episode is long in duration the chances are that it is a pseudoseizure
  • Pelvic thrusting does not usually happen during an epileptic episode
  • Side to side movements of head and body usually happen in a pseudoseizure
  • Eye closing, especially forced eye closing almost always is a pseudoseizure
  • Ictal crying is usually a pseudoseizure
  • Most of the time there is no or very brief post-ictal period with pseudoseizure
  • Put these patients on ETCO2 – in a true epileptic episode, the O2 saturation will go down and the CO2 will go up
  • Video EEG monitoring is the gold standard for diagnosing pseudoseizures, but it does not have good accuracy in the diagnosis of PNES
  • Seizure movement is more variable in PNES than in epilepsy
  • Opisthotonus is more common in PNES
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