Clinical ResearchEpileptic vs psychogenic nonepileptic seizures: a video-based survey

- PNES is commonly misdiagnosed, leading to ineffective, costly, hazardous treatment.
- Neurologists and specifically epileptologists show a good diagnosing ability based on semiology.
- First responders have a low diagnosing ability of PNES.
- Video taking by surrounding with the use of telemedicine can prevent misdiagnosis.

Psychogenic non epileptic seizures (PNES) are present in up to 30% of patients undergoing video EEG. Delay in PNES diagnosis is an average of 7.2 years. Patients are exposed to costly, hazardous medications and other iatrogenic morbidities. Our aim was to investigate the ability to correctly diagnose ES from PNES in different groups and seniorities of medical professionals based on video alone. We showed ten video episodes' recordings (5 PNES, 5 ES) to doctors and nurses from ER, Internal Medicine ward and Neurology department, and inquired about the episodes' nature. 46 participants, 26 non-neurological and 20 neurological personnel. Seniority of responders varied. Epileptologists diagnosed correctly 87.5% of cases, General neurologists 72.8%. Neurology nurses 69.8%, ER nurses 58%, Internal Medicine physicians 54.1% and ER physicians 44.4%. Statistical significant difference between the general physicians to all neurology group professions was > 0.05. We pointed out the lack of awareness of first responders to patients presenting with seizures. Neurologist ability to recognize seizures using semiology alone is higher than other medical personnel. Take home messages is the need for video taking of episodes and education plan to first responders.