Resetting of brain dynamics: epileptic versus psychogenic nonepileptic seizures

We investigated the possibility of differential diagnosis of patients with epileptic seizures (ES) and patients with psychogenic nonepileptic seizures (PNES) through an advanced analysis of the dynamics of the patients' scalp EEGs. The underlying principle was the presence of resetting of brain's preictal spatiotemporal entrainment following onset of ES and the absence of resetting following PNES. Long-term (days) scalp EEGs recorded from five patients with ES and six patients with PNES were analyzed. It was found that: (1) Preictal entrainment of brain sites was reset at ES (P < 0.05) in four of the five patients with ES, and not reset (P = 0.28) in the fifth patient. (2) Resetting did not occur (p > 0.1) in any of the six patients with PNES. These preliminary results in patients with ES are in agreement with our previous findings from intracranial EEG recordings on resetting of brain dynamics by ES and are expected to constitute the basis for the development of a reliable and supporting tool in the differential diagnosis between ES and PNES. Finally, we believe that these results shed light on the electrophysiology of PNES by showing that occurrence of PNES does not assist patients in overcoming a pathological entrainment of brain dynamics. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction.

► Abnormal long-term entrainment of brain dynamics precedes Epileptic Seizures (ES). ► Resetting of this pathology of dynamics is typically observed after occurrence of ES. ► Brain dynamics are not reset after Psychogenic Non-Epileptic Seizures (PNES). ► EEG dynamics shed a novel light on the electrophysiological underpinnings of PNES. ► Analysis of brain dynamics could be used in the differential diagnosis of ES and PNES.