Abstracts

Analysis of the semiology of psychogenic non-epileptic seizures (PNES) is challenging. Use of the same terminology as that used for epileptic phenomema may be inappropriate for PNES. Groppel et al. suggested a classification based on the analysis of clusters of symptoms and signs. In this study we applied this classification to the analysis in order to analyze its application and possible limitations, We studied the semiology of 27 patients with PNES documented by VEEG. We observed and characterized motor phenomena, classifying them as events with positive motor phenomena ([italic]clonic[/italic], hypermotor, tremors, pelvic thrusting, lateralized movements, versive, erratic and anomalous movements simulating automatisms, hypertonic posture, retropulsion with or without opistotonus) or as events with negative motor phenomena (loss of tonus, motor arrest, staring, etc). We also evaluated responsiveness, hyperventilation, sound emission and [italic]aura[/italic]. Postictal phenomena and event duration were likewise evaluated., Eight patients were classified as Cluster I (hypermotor and clonic movements of extremities, pelvic thrusting, head movements, tonic head posture - motor PNES); 4, as Cluster II (limb tremor - minor motor PNES) and 4 as Cluster III ([ldquo][italic]atonic[/italic] PNES[rdquo]). Six patients had more than one event, with distinct semiology, being classified in two groups.
Fifteen NES could not be classified according to these criteria.
Among those presenting positive motor phenomena, 4 had Cluster I phenomena associated to tremors (Cluster II), and 3 had Cluster I phenomena associated to [italic]automatisms[/italic], 2 patients had only automatic movements and 1, had subtle lateralization movements.
Not all patients with negative motor phenomena had atonia; 2 had speech arrest, 1 had irresponsiveness, 1 had visual hallucinations, and 2 had irresponsiveness with eye flutter. Ten patients had hyperventilation, 12 with whimpering, and less often, wailing.
Loss of responsiveness was observed in 16 patients from this group. Four patients reported [italic]aura[/italic] preceding the event. Postictal confusion with agitation was observed in 6 patients. Twelve patients presented events with prolonged duration., Our study suggested that although the attempt of a categorical classification of PNES, such as that carried out in epileptic seizures and syndromes, may seem quite interesting, it seems to be of little practical use because of the heterogeneity of PNES. PNES do not always present as stereotyped seizures in the same patient and frequently undergoes changes in semiology during its course. Moreover, in the literature there is a tendency to overestimate motor phenomena, when other non-motor features may be just as important for diagnosis of PNES and remain undervalued.
Groppel G, et al. Cluster analysis of clinical seizure semiology of psychogenic nonepileptic seizures. Epilepsia 2000;41(5):610-4.,