Psychogenic non-epileptic seizures (PNES) in the context of concurrent epilepsy – making the right diagnosis

Abstract Epilepsy is a risk factor for the development of psychogenic non-epileptic seizures (PNES) and comorbid epilepsy recognized as comorbidity in about 10–30% patients with PNES. The combination epileptic nonepileptic poses particular diagnostic challenge. In epilepsy, additional PNES may be suspected on basis their typical semiology. possibility should also considered if fail to respond antiepileptic drug treatment, frequent emergency admissions those who develop new types seizures. description semiological details by witnesses can suggest Home video recordings support an initial diagnosis, however, especially mixed seizure disorders it advisable seek further confirmation capturing all habitual video-EEG. clinical features associated are similar isolated include longer duration, fluctuating course, asynchronous movements, pelvic thrusting, side-to-side head or body movement, persistently closed eyes mouth, ictal crying, recall experiences absence postictal confusion. present syncope-like episodes unresponsiveness reduced muscle tone. There no unique epileptological brain pathology profile putting at However, typically have lower educational achievements higher levels psychiatric comorbidities than alone. Psychological trauma, including sexual abuse, appears less relevant aetiological PNES, gender imbalance (i.e. greater prevalence women) marked sometimes after surgery. A diagnosis ‘known epilepsy’ never accepted without (at least brief) critical review. This narrative review summarises clinical, electrophysiological historical that help identify