Nonepileptic psychogenic status: Markedly prolonged psychogenic nonepileptic seizures

Little is known about markedly prolonged psychogenic nonepileptic seizures (PNES) though they are reported in up to 78% of PNES. Entry to the tertiary referral epilepsy monitoring unit (EMU) is often urgent and the stay usually brief, resulting thus far in almost no data regarding outcomes. The American Epilepsy Society (AES) Nonepileptic Seizure Task Force was asked to gather evidence for consensus of practice and treatment for PNES and its spectrum. As part of the subcommittee focusing on “pseudostatus epilepticus,” we sent questionnaires to AES membership inquiring about markedly prolonged events, which we call nonepileptic psychogenic status (NEPS). Ninety U.S. and international neurologists from at least 19 states in the United States responded, with approximately 45% reporting that they do not distinguish NEPS from PNES. Eighty percent of responders considered a period of 20 minutes or longer as “prolonged.” Lack of consensus between responders on how to manage these patients was uncovered. The NES Task Force subcommittee on “pseudostatus” recommends that the duration of PNES is tracked and those events lasting 20 minutes or longer, with or without change in level of consciousness, are considered NEPS. Future research needs are discussed.