title: Semiological characteristics of adults with psychogenic nonepileptic seizures (PNESs): an attempt towards a new classification.
abstract: This study was carried out to analyze the semiological characteristics of adults with psychogenic nonepileptic seizures (PNESs) and to propose a modified new classification of PNESs. This retrospective analysis included 82 patients (M:F=38:44; mean age: 33.4 ± 12.0 years) diagnosed to have PNESs based on video-EEG recording. Detailed semiological characteristics including pattern of limb movements, body movements, psychological/emotional manifestations, "aura", level of consciousness, age at onset of PNESs, age at diagnosis, and history of AED intake were recorded. We classified our cohort of patients as per available classifications and proposed a modified new classification. Age at onset of PNESs was 21.8 ± 14.1 years (range: 2-64; median: 18.5 years), age at diagnosis was 29.3 ± 12.7 years (range: 2-67; median: 26.0 years), and delay in diagnosis was 7.4 ± 7.3 years (range: 0-28; median: 5.0 years). There were 369 recorded attacks (range: 1-10; median: 4). Prior to VEEG, 47 (57.3%) patients were incorrectly diagnosed as having true epileptic seizures initially and were on antiepileptic drugs (AEDs), 15 (18.3%) patients had an initial diagnosis of PNESs which remained unchanged after VEEG analysis, and 20 (24.4%) patients had both PNESs and epileptic seizures. We could not classify 40-66% of our patients into any of the available classification proposed by previous authors. We categorized all our patients into the following categories of a modified new classification: abnormal hypermotor response: 23 (28%), abnormal partial motor response: 18 (22%), affective/emotional behavior phenomena: 4 (4.9%), dialeptic type: 5 (6.1%), nonepileptic aura: 5 (6.1%), and mixed pattern: 27 (32.9%). Incorrect diagnosis of PNESs leads to unnecessary prescription of AEDs, with side effects and cost implications. A modified systematic classification of PNESs is proposed which would help in the better characterization of PNESs.
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Dhiman
authors.forename: Sanjib
authors.initials: S
authors.lastname: Sinha
authors.forename: Vikram Singh
authors.initials: VS
authors.lastname: Rawat
authors.forename: Thippeswamy
authors.initials: T
authors.lastname: Harish
authors.forename: Santosh K
authors.initials: SK
authors.lastname: Chaturvedi
authors.forename: Parthasarathy
authors.initials: P
authors.lastname: Satishchandra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D015331:Cohort Studies; D003291:Conversion Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000145:classification* / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D012720:Severity of Illness Index; D014741:Video Recording; D055815:Young Adult
chemical_list: D000927:Anticonvulsants