Sémiologie motrice oubliée : les crises non épileptiques psychogènes

Psychogenic Non Epileptic Seizure (PNES) are defined as paroxysmal and transient behavioral manifestations, suggestive of epileptic seizures, but without the concomitant electro physiological activity linked to an epileptic seizure. There is a net female predominance (75 %). The beginning of illness is typically in the second or third decade. About 80 % patients have antecedents of traumatisms. The understanding of PNES requires the analysis of three types of factors (3P): predisposing, precipitating, and perpetuating factors. These factors all are not always found. There would be a correlation between the dysfunction of some cerebral networks and the dissociation for patients suffering from PNES. There would be a complex emotional dysfunction for some patients suffering from PNES. The semiological analysis in video-EEG allows to identify characteristic associations of signs during seizure allowing to differentiate five clinical subcategories which linked to the semiological analysis of 3 P allow to diagnose PNES. The diagnostic announcement of PNES is a delicate stage, but important to start a first therapeutic stage: it conditions the forecast of the patients suffering from PNES. The diagnostic announcement and the taking care require a close collaboration between neurologists and psychiatrists.