Psychogenic Nonepileptic Seizure Patterns in Patients With Epilepsy

BackgroundPsychogenic nonepileptic seizures (PNESs) clinically resemble epileptic seizures (ESs) without concomitant electroencephalograph (EEG) changes. Although most studies focus on the differences between ESs and PNESs in different groups of patients, few studies have focused on patients with a comorbidity of PNESs and ESs.ObjectivesThe aim of this study, was to establish the pattern of relationships between PNESs and ESs in patients who had both types of events during long-term video EEG monitoring, expecting to find that PNESs would be longer, more frequent, and more dramatic than ESs.MethodsThis retrospective study included only patients who had both ESs and PNESs during long-term video EEG monitoring.Results12 patients with both types of seizures during long-term video EEG monitoring were recruited. Taking into account the hypothesized differentiating pattern (number of PNESs ≥ ESs, duration of PNESs ≥ ESs, and semiology of PNESs ≥ ESs), in 8 patients, all 3 conditions were fulfilled; in 3, 2 conditions were fulfilled; and in only 1, none of the conditions were fulfilled.ConclusionAlthough there are semiological similarities between PNESs and ESs in the PNES + ES group of patients, there is still a recognizable pattern of differences between these 2 states, with characteristics of PNESs resembling those of PNESs in patients with PNESs alone—dramatic and prolonged seizures. Provoking PNESs during long-term video EEG monitoring can cause diversion from the pattern, raising the suspicion of provoking pseudo-PNESs. Although this finding needs to be further investigated provocation should be used cautiously.