Acta Epileptologica volume 2 , Article number: 7 Cite this article. Metrics details. Distinguishing non-epileptic events, especially psychogenic non-epileptic seizures PNES , from epileptic seizures ES constitutes a diagnostic challenge. In emergency units, a misdiagnosis can lead to extreme antiepileptic drug escalade, unnecessary resuscitation measures intubation, catheterization, etc. Outside of the acute window, an incorrect diagnosis can lead to prolonged hospitalization or increase of unhelpful antiepileptic drug therapy.
Early recognition is thus desirable to initiate adequate treatment and improve prognosis. Considering experience-based strategies and a thorough review of the literature, we aimed to present the main clinical clues for physicians facing PNES in non-specialized units, before management is transferred to epileptologists and neuropsychiatrists.
In such conditions, patient recall or witness-report provide the first orientation for the diagnosis, recognizing that collected information may be inaccurate. Thorough analysis of an event live or based on home-video may lead to a clinical diagnosis of PNES with a high confidence level.
Prolactinemia may also be a useful biomarker to distinguish PNES from epileptic seizures, especially following bilateral tonic-clonic seizures. Finally, regardless the level of certainty in the diagnosis of the PNES, it is important to subsequently refer the patient for epileptological and neuropsychiatric follow-up. A friend found him in his bedroom 30 minutes earlier and called emergency services.
The patient reports having had seven convulsions, each lasting more than 15 minutes, over the last 3 hours. These events occurred while he was studying for his final exams. What is your approach? Indeed, the fact that the patient was able to give precise details about his recent history after seven close seizures is questionable. Other cues are disseminated in the clinical summary above.
