Abstracts

Rationale: The analysis of the semiological findings is essential for the diagnosis Psychogenic Nonepileptic Seizures (PNES). There are many signs described as useful to differentiate PNES from epileptic seizures (eg, ictal eye closure). In this study, we aimed to compare these signs in different ages, gender and patients with epilepsy as a comorbidity. Methods: Retrospective review of the medical records and VEEG records of all patients diagnosed as presenting PNES in the Comprehensive Epilepsy Center of the IPq HCFMUSP. 25 signs were selected as the most prevalent in literature and its presence was analyzed. Events were also categorized as: catatonic, major motor, minor motor and subjective.Results: A total of 115 patients were included, 85 (66.9%) were adults and 42 were children (13[30.9%] under the age of 11 years), 73.2% were females, and 14.4% had epilepsy. Motor phenomenon lasting more than 2 minutes (49.2%), asynchronous limb movements (41.7%), rapid postictal reorientation (34.6%), ictal eye closure (27.6%) and pelvic thrust movements (26%) were the most frequent signs. Comparing the presence of these signs in children and adults, the latter group presented more ictal eye closure (p=0.01), convulsion lasting more than 2 minutes (p<0,01), vocalization during tonic tonic-clonic phase (p=0.02), pelvic thrust movement (p=0.09) and opisthotonus (p=0.07). Tongue biting, tip or side, were both rare and only presented by adults. As for the semiological categories, major motor activity was the main feature in adults (52.9%) and minor motor activity was more prevalent among the children (38.1%), with statistical difference (p=0.01). No differences were found comparing gender and patients with and without epilepsy. Conclusions: Our data showed that classic signs used to differentiate PNES from epileptic seizures in adults are not relevant in children, suggesting that age plays a pivotal role in the semiology of PNES.