Ali A Asadi-Pooya1, Jennifer Tinker2, Elizabeth W Fletman3. 1. Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States. Electronic address: aliakbar.asadi-pooya@jefferson.edu. 2. Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States. Electronic address: jennifer.tinker@jefferson.edu. 3. Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States. Electronic address: Elizabeth.Fletman@jefferson.edu.
Abstract
PURPOSE: To classify patients with psychogenic nonepileptic seizures (PNES) according to a recently proposed classification system and investigate the variability of PNES semiology. METHODS: We retrospectively investigated all patients with PNES admitted at the Jefferson Comprehensive Epilepsy Center from 2012 through 2016. We classified their seizures after retrospectively reviewing their recorded videos during their video-EEG monitoring admission and investigated the seizure variability. We extracted all the clinical data from their medical records. We also studied factors potentially associated with seizure variability. RESULTS: Forty nine patients were studied and 220 seizures were reviewed and classified. Mean number of seizures per patient was 4.5. Twenty seven (55%) patients had subjective seizures, 26 (53%) had generalized motor, 14 (29%) had akinetic and five (10%) had focal motor seizures. Twenty eight (57%) patients had only one seizure class, while 19 (39%) patients had two different seizure classes and two (4%) patients had three seizure classes. Among 28 patients with one seizure class, 14 (50%) patients had variable semiologies from one seizure to the other. Hence, 71.5% of the patients showed either inter- or intra-class variability, whereas seizures were stereotypical in 28.5%. No demographic or clinical factors were significantly associated with variability of PNES semiology. CONCLUSION: Neither the stereotypy nor the variability of PNES can or should be used as a marker of the disease and to differentiate PNES from epilepsy. The variability of the episodes of PNES does not hinder an appropriate classification of these seizures.
PURPOSE: To classify patients with psychogenic nonepileptic seizures (PNES) according to a recently proposed classification system and investigate the variability of PNES semiology. METHODS: We retrospectively investigated all patients with PNES admitted at the Jefferson Comprehensive Epilepsy Center from 2012 through 2016. We classified their seizures after retrospectively reviewing their recorded videos during their video-EEG monitoring admission and investigated the seizure variability. We extracted all the clinical data from their medical records. We also studied factors potentially associated with seizure variability. RESULTS: Forty nine patients were studied and 220 seizures were reviewed and classified. Mean number of seizures per patient was 4.5. Twenty seven (55%) patients had subjective seizures, 26 (53%) had generalized motor, 14 (29%) had akinetic and five (10%) had focal motor seizures. Twenty eight (57%) patients had only one seizure class, while 19 (39%) patients had two different seizure classes and two (4%) patients had three seizure classes. Among 28 patients with one seizure class, 14 (50%) patients had variable semiologies from one seizure to the other. Hence, 71.5% of the patients showed either inter- or intra-class variability, whereas seizures were stereotypical in 28.5%. No demographic or clinical factors were significantly associated with variability of PNES semiology. CONCLUSION: Neither the stereotypy nor the variability of PNES can or should be used as a marker of the disease and to differentiate PNES from epilepsy. The variability of the episodes of PNES does not hinder an appropriate classification of these seizures.
Authors: Wesley T Kerr; Andrea M Chau; Emily A Janio; Chelsea T Braesch; Justine M Le; Jessica M Hori; Akash B Patel; Norma L Gallardo; Janar Bauirjan; Corinne H Allas; Amir H Karimi; Eric S Hwang; Emily C Davis; Albert Buchard; David Torres-Barba; Shannon D'Ambrosio; Mona Al Banna; Andrew Y Cho; Jerome Engel; Mark S Cohen; John M Stern Journal: Seizure Date: 2019-03-05 Impact factor: 3.184