Insights from Video-EEG Monitoring: Semiological Features of Psycogenic Nonepileptic Seizures. Buenos Aires, Argentina
Abstract number :
2.089
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2021
Submission ID :
1825969
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
ANILU DAZA RESTREPO, MD - Hospital el Cruce Néstor Kirchner; alejandro Nasimbera - MD, Hospital El Cruce Néstor Kirchner; Brenda Giagante - MD, Hospital El Cruce Néstor Kirchner; Silvia Oddo - MD, Hospital El Cruce Néstor Kirchner; luciana D´alessio - MD, Hospital El Cruce Néstor Kirchner; laura Scévola - MD, Hospital El Cruce Néstor Kirchner; Patricia Solis - MD, Hospital El Cruce Néstor Kirchner; Ernesto Stivala - MD, Hospital El Cruce Néstor Kirchner; Mercedes Sarudiansky - MD, Hospital El Cruce Néstor Kirchner; Nuria Cámpora - MD, Hospital El Cruce Néstor Kirchner; Carolina Lomlomdjian - MD, Hospital El Cruce Néstor Kirchner; Juan Pablo Princich - MD, Hospital El Cruce Néstor Kirchner; Pablo Seoane - MD, Hospital El Cruce Néstor Kirchner; Silvia Kochen - MD, Hospital El Cruce Néstor Kirchner
Rationale: Psychogenic Non-epileptic seizures (PNES), or Functional seizures are paroxysmal events that resemble epileptic seizure but are NOT associated with epileptiform activity and have a psychogenic nature. Present in 5-20% of patients with epilepsy and 15-40% of adults referred to Epilepsy Centers. Given their varied clinical presentation, they represent a real diagnostic challenge.
AIM: Categorize semiological features observed in psychogenic non-epileptic seizures (PNES) during Video-EEG (VEEG) monitoring to improve clinical diagnosis.
Methods: Retrospective observational study in patients(p) admitted to VEEG Unit. Hospital El Cruce Dr Néstor Kirchner and Hospital de Agudos Ramos Mejía period 2016-2020. Recording of patients with PNES, with or without epilepsy, were reviewed. The semiology of each event was visually analyzed. We evaluated the presence of 19 semiological signs. We classified it in four groups: Hypermotor, Akinetic, Focal Motor and subjective symptoms. We used the following psychiatric assessment: DSM-IV, SCID-I and SCID-II structured interview, EEAG and Beck Depression Inventory.
Results: 330 Video-EEG studies were performed during the period studied, 61p met the inclusion criteria (18.5%), 47 (77%) women; mean age was 33y (14 to 74), educational level: Elementary or High school in 44 (83%), superior in 9 (16%). Singles 37 (61%) currently employed 12 (20%); 41p (67%) were classified in the PNES-only group and 20p (33%) in the PNES and Epilepsy group. Mean onset of PNEs was 26yr. Average time before diagnosis was 6yr. Family history of epilepsy in 11p (18%), history of head trauma in 7p (11), depression 32p (53%), anxiety 18p (30%). 98% were on medication with AEDs, mean 4 AED´s (1 to 7). First PNES was recorded after 16hr in VEEG (1–90hr). Number of PNES on VEEG were 4 (1 to 30), average time of the longest PNES was 8.33mn (1-60mn). According to the semiological signs, 40p (621%) presented Hypermotor, Focal motor in 15p (25%), Akinetic in 14p (23%) subtypes. Multiple types of seizures were presented in 34p, (56%).
Major semiological signs in PNES were: closed eyes, asynchronous movements, closed hands, head movements, stiffness or generalized tonic clonic posture and body rocking (p < 0.05). Focal motor PNES were predominant in females (p < 0.05); we found a proportion 3:1 with female gender.
Clinical Epilepsy