Podcast 650: PNES

Contributor: Katie Sprinkel, MD

Educational Pearls:

• Psychogenic Non-Epileptic Seizures (PNES) are due to a psychogenic rather than an epileptic cause
• Despite common assumption, PNES are not always volitional
• 20-40% of those with PNES can also have true epileptic seizures 20-40%
• True diagnosis requires a video EEG
• Characteristics of PNES include:
• • Waxing and waning of the seizure intensity
  • Eyes clenched shut
  • Pelvic thrusting, rolling from side-to-side
  • Ability to respond to verbal stimuli during the seizure
  • Ability to recall information during the seizure
  • Weeping or stuttering
  • Guarding the face on passive hand drop
• Characteristics of epileptic seizures:
• • Tongue biting
  • Prolonged postictal state
  • Incontinence
• Haldol or Zyprexa may be better for PNES and benzodiazepines tend to be better for epileptic seizures

References

Huff JS, Murr N. Psychogenic Nonepileptic Seizures. 2021 Jan 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 28722901.

Asadi-Pooya AA. Psychogenic nonepileptic seizures: a concise review. Neurol Sci. 2017 Jun;38(6):935-940. doi: 10.1007/s10072-017-2887-8. Epub 2017 Mar 8. PMID: 28275874.

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD