Psychogenic nonepileptic seizure: An empathetic, practical approach

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Figure 1
Algorithm for diagnosing psychogenic nonepileptic seizure (PNES).
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Figure 2
A variety of predisposing, precipitating, and perpetuating factors contribute to psychogenic nonepileptic seizure (PNES). Patients with PNES typically have multiple contributing factors.

TABLE 1

Clinical features that may suggest psychogenic nonepileptic seizure^a

Long duration (> 10 minutes) of convulsive-type seizures

Convulsive-type seizures with retained awareness

Side-to-side head movements during convulsive-type seizures

Out-of-phase limb movements

Eyes-closed unresponsiveness

Pelvic thrusting

Fluctuating patterns of movement

Distractibility during the seizure

Crying during the seizure

Stuttering during the seizure

↵a No one sign is 100% specific for psychogenic nonepileptic seizure. History alone is not a substitute for confirmation with video electroencephalography.