What signs and symptoms of psychogenic nonepileptic seizures (PNES)?

Updated: Jul 26, 2018
  • Author: Selim R Benbadis, MD; Chief Editor: Helmi L Lutsep, MD  more...
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In particular, some characteristics of the motor (i.e., convulsive) phenomena are associated with PNES (see EEG Video Monitoring). Common and helpful symptoms include side-to-side shaking of the head, bilateral asynchronous movements (e.g., bicycling), weeping, stuttering, and arching of the back. (See video below.) In a study of 120 seizures (36 PNES and 84 epileptic seizures) from 35 patients, only a few signs were reliable in predicting the diagnosis. PNES were predicted by preserved awareness, eye flutter, and episodes affected by bystanders (intensified or alleviated). Epileptic seizures were predicted by abrupt onset, eye-opening/widening, and postictal confusion/sleep. In addition, as compared with signs viewed on video recording, eyewitness reports of these signs were not reliable. [6] It is important to emphasize that no sign isitselfdiagnostic or 100% specific, but fortunately most patients have several of them.

Psychogenic nonepileptic attacks. The event is provoked by an induction (or provocative) technique. Note the typical irregular nonclonic nontonic and asynchronous movements (including bicycling) with stop-and-go phenomenon.

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