title: Psychogenic non-epileptic seizures: our video-EEG experience.
abstract: OBJECTIVE
  The aim of our study was to assess the number of psychogenic non-epileptic seizures (PNES) in our patients with a refractory seizure disorder, to determine the 'typical' PNES semiology using video-EEG monitoring and describe other PNES parameters.
  
  
  METHODS
  We evaluated prospectively 596 patients with pharmacoresistant seizures. All these patients underwent continuous video-EEG monitoring. In consenting patients, we used suggestive seizure provocation. We assessed seizure semiology, interictal EEG, brain MRI, psychiatric co-morbidities, personality profiles, and seizure outcome.
  
  
  RESULTS
  In the sample of 596 monitored patients, we detected 111 (19.3%) patients with PNES. Of the 111 patients with PNES, 86.5% had spontaneous and 76.5% had provoked seizures. The five most typical symptoms were: initially closed eyelids (67.6%), rapid tremor (47.7%), asynchronous limb movement (37.8%), preictal pseudosleep (33.3%), and side-to-side head movement (32.4%). Interictal EEG was rated as abnormal in 46.2% and with epileptiform abnormality in 9%. Brain MRI was abnormal in 32 (28.8%) patients. Personality disorders (46.8%), anxiety (39.6%), and depression (12.6%) were the most frequent additional psychiatric co-morbidities. PNES outcome after at least 2 years is reported; 22.5% patients was seizure-free; one-third had markedly reduced seizure frequency. We have not seen any negative impact of the provocative testing on the seizure outcome.
  
  
  CONCLUSIONS
  Video-EEG monitoring with suggestive seizure provocation supported by clinical psychiatric and psychological evaluation significantly contributes to the correct PNES diagnosis, while interictal EEG and brain MRI are frequently abnormal. Symptoms typical for PNES, as opposed to epileptic seizures, could be distinguished.
authors.affiliation: Department of Neurology, Epileptology and Neuropsychiatry, Na Františku Hospital, Prague, Czech Republic.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Nežádal
authors.forename: Jiří
authors.initials: J
authors.lastname: Hovorka
authors.forename: Erik
authors.initials: E
authors.lastname: Herman
authors.forename: Iveta
authors.initials: I
authors.lastname: Němcová
authors.forename: Michal
authors.initials: M
authors.lastname: Bajaček
authors.forename: Eva
authors.initials: E
authors.lastname: Stichová
mesh_terms: D000328:Adult; D001921:Brain / Q000503:physiopathology*; D058256:Brain Waves / Q000502:physiology; D003937:Diagnosis, Differential; D004351:Drug Resistance; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D010552:Personality Assessment; D011446:Prospective Studies; D011613:Psychotherapy / Q000379:methods; D011619:Psychotropic Drugs / Q000627:therapeutic use; D016896:Treatment Outcome; D014741:Video Recording / Q000379:methods*
chemical_list: D011619:Psychotropic Drugs