Differentiating psychogenic nonepileptic from epileptic seizures: A mixed-methods, content analysis study, 2020, Cardéna et al

[Andy]

BACKGROUND:
Identification of clinical features that might distinguish psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES) is of value for diagnosis, management, and understanding of both conditions. Previous studies have shown that patients' descriptions of their seizures reflect differences in content and delivery. We aimed to compare verbal descriptions of PNES and ES using a mixed-methods approach.

METHODS:
We analyzed data from semi-structured interviews in which patients with video-electroencephalography (EEG)-confirmed ES (n = 30) or PNES (n = 10) described their seizures. Two masked raters independently coded the transcripts for relevant psychological categories and discrepancies that were noted and resolved. Additional analyses were conducted using the Linguistic Inquiry and Word Count system. The identified phenomena were descriptively compared, and inferential analyses assessed group differences in frequencies. A logistic regression analysis examined the predictive power of the most distinctive phenomena for diagnosis.

RESULTS:
As compared with ES, PNES reported longer seizures, more preseizure negative emotions (e.g., fear), anxiety symptoms (e.g., arousal, hyperventilation), altered vision/olfaction, and automatic behaviors. During seizures, PNES reported more fear, altered breathing, and dissociative phenomena (depersonalization, impaired time perception). Epileptic seizures reported more self-injurious behavior. Postseizure, PNES reported more fear and weeping and ES more amnesia and aches. The predictive power when including these variables was 97.5%. None of the single predictor variables was significant. The few but consistent linguistic differences related to the use of some pronouns and references to family.

CONCLUSIONS:
Although no single clinical feature definitively distinguishes PNES from ES, several features may be suggestive of a PNES diagnosis, including longer duration, negative emotion (i.e., fear) throughout the events, preseizure anxiety, ictal dissociation, and postseizure weeping. Fewer reports of ictal self-injury and postseizure amnesia and aches may also indicate the possibility of PNES.

Direct link to open access PDF, https://www.epilepsybehavior.com/article/S1525-5050(20)30300-0/pdf

 

[Snowdrop]

If they were trying to differentiate people already diagnosed they'd need to account for medication. People with epileptic seizures would likely be medicating while people deemed to have psychogenic epilepsy would not.

This would definitely make a difference in how a person behaved pre and post seizure and possibly even affect how long the seizure lasted.

Also, it goes to show how little progress has been made in the field of neurology. I had my EEG over 50 years ago. Not much has changed in the technology, quite possibly due to neurology being infested with psychiatry people. There was no hesitating as to whether getting an EEG for diagnosis was overusing resources as implied in the text here.

Money saving and liaison psychiatry. The deadly combination. Kills people and medical progress.

 

[rvallee]

Such pretty dance moves the angels make on their hairpins.

The predictive power when including these variables was 97.5%. None of the single predictor variables was significant. The few but consistent linguistic differences related to the use of some pronouns and references to family.

Completely delusional. These people are out of their damned minds and have no concept of the impact of what their delusions impose on vulnerable people.

 

[spinoza577]

Although no single clinical feature definitively distinguishes PNES from ES, several features may be suggestive of a PNES diagnosis, including longer duration, negative emotion (i.e., fear) throughout the events, preseizure anxiety, ictal dissociation, and postseizure weeping.

I have a psychogenic seizure right now ...