Diagnostic Challenges of Psychogenic Nonepileptic Seizures

Abstract

Objectives: Psychogenic nonepileptic seizures (PNES) resemble epileptic seizures. Accurate diagnosis of PNES can be challenging, and mis-diagnosis and treatment confusion is common. This article is a review of patients with PNES who were initially diagnosed with epilepsy. Methods: Records of 1140 patients referred to the epilepsy center at Antalya Education and Research Hospital with diagnosis of epilepsy were retrospectively reviewed. Demographic characteristics, risk factors, and diagnostic methods were analyzed. Results: A total of 70 patients, 54 (77.1%) female and 16 (22.9%) male patients, were diagnosed with PNES. In 24 patients (34.3%), PNES alone was diagnosed, 46 patients (65.7%) had epilepsy and PNES. In the strictly PNES patients, there were abnormal electroencephalogram (EEG) findings in 10 (41.6%) patients, nonspecific changes in cranial magnetic resonance imaging (MRI) of 5 (20.8%), risk factors were found in 6 (25%), and 7 (29.2%) patients had family history of seizures. Conclusion: It is important to keep PNES in mind if epilepsy is suspected when evaluating patients with risk factors or EEG or MRI abnormalities in order to avoid misdiagnosis. History of seizures, semiological features and objective data should all be carefully evaluated to determine appropriate treatment plan.