Differentiating psychogenic nonepileptic from epileptic seizures: A mixed-methods, content analysis study

Abstract

Background: Identification of clinical features that might distinguish psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES) is of value for diagnosis, management, and understanding of both conditions. Previous studies have shown that patients' descriptions of their seizures reflect differences in content and delivery. We aimed to compare verbal descriptions of PNES and ES using a mixed-methods approach. Methods: We analyzed data from semi-structured interviews in which patients with video-electroencephalography (EEG)-confirmed ES (n = 30) or PNES (n = 10) described their seizures. Two masked raters independently coded the transcripts for relevant psychological categories and discrepancies that were noted and resolved. Additional analyses were conducted using the Linguistic Inquiry and Word Count system. The identified phenomena were descriptively compared, and inferential analyses assessed group differences in frequencies. A logistic regression analysis examined the predictive power of the most distinctive phenomena for diagnosis. Results: As compared with ES, PNES reported longer seizures, more preseizure negative emotions (e.g., fear), anxiety symptoms (e.g., arousal, hyperventilation), altered vision/olfaction, and automatic behaviors. During seizures, PNES reported more fear, altered breathing, and dissociative phenomena (depersonalization, impaired time perception). Epileptic seizures reported more self-injurious behavior. Postseizure, PNES reported more fear and weeping and ES more amnesia and aches. The predictive power when including these variables was 97.5%. None of the single predictor variables was significant. The few but consistent linguistic differences related to the use of some pronouns and references to family. Conclusions: Although no single clinical feature definitively distinguishes PNES from ES, several features may be suggestive of a PNES diagnosis, including longer duration, negative emotion (i.e., fear) throughout the events, preseizure anxiety, ictal dissociation, and postseizure weeping. Fewer reports of ictal self-injury and postseizure amnesia and aches may also indicate the possibility of PNES.

Differentiation of epilepsy and psychogenic nonepileptic events based on body fluid characteristics

“…Although the pathophysiology of PNEEs is still poorly understood compared to epilepsy, the increased respiratory rate or hyperpnea during and after PNEEs has been reported 24–26 . This activated respiratory pattern has also been used in previous studies to differentiate PNEEs from epilepsy 27,28 …”

“…[24][25][26] This activated respiratory pattern has also been used in previous studies to differentiate PNEEs from epilepsy. 27,28 The concentration of several ions was also ranked as important features of the random forest model, including calcium, chloride, and potassium. This may be related to the mechanisms in epileptogenesis of dysfunction of structures responsible for maintaining ionic homeostasis.…”

Prevalence and risk factors of psychogenic non-epileptic seizures (PNES) among adult Sudanese epileptic patients who attend Dauod charity clinic, Sudan, 2021

“…Fewer reports of ictal self-injury and post-seizure aches and amnesia may also favors the possibility of PNES. [23] Risk factors:…”

The Comparison Between Neuropsychological Features of Psychogenic Non-epileptic Seizures and Epileptic Seizures

“…However, many of these medications can cause adverse effects for patients (6) and impose costs on patients, communities, and healthcare systems (7). Therefore, finding accurate and available ways to diagnose and differentiate these two disorders can help specialists determine the etiology and dynamics of both disorders (10).…”

“…Some studies have also reported better cognitive performance in PNES, while others have reported worse cognitive performance in comparison with ES (13,14). Neuropsychological assessments can provide clues for the differential diagnosis of PNES and ES and help clarify their nature and etiology (6,10).…”