Semiological features of psycogenic nonepileptic seizures: insights from Video-EEG monitoring in epilepsy reference center in Buenos Aires, Argentina

DAZA RESTREPO A; PÉREZ A. C; NASIMBERA A; KOCHEN S; GIAGANTE B; ODDO S; D´ALESSIO L; LOMBARDI N; SCÉVOLA L

Bangkok

Congreso; Word Epilepsy Congress; 2019

ILAE

Purpose: Categorize semiological features observed inpsychogenic nonepileptic seizures (PNES) during Video-EEG (VEEG) monitoring toimprove clinical diagnosis.Method: Retrospective observational study in patients(p) admitted toVEEG during 2014-2018. Recording of patients with PNES, with or withoutepilepsy, were reviewed. The semiology of each event was visually analyzed andentered into a database, in which the signs and symptoms were classified infour groups according to the prominent semiological finding: Hypermotor,Motionless, Total lack of Responsiveness and the presence of Aura. Othersymptoms were also included.Results: 379 Video-EEG studies were performed during the period studied,53p (14%) met the inclusion criteria, 42 (79%) women. A total of 259 PNES wereanalyzed; 34p were classified in the PNES-only group and 19 in the PNES andEpilepsy group. Mean age was 33yr (15 to 83). Mean onset of PNEs was 26yr.Average time before diagnosis was 6yr. First event was recorded after 16hr inVEEG (1-90hr). Number of events was 4 (1 to 30). As for the treatment, 98% wereon medication with AEDs, mean 4 AED´s (1 to 7). According to the semiologicalcharacterization, 40p (75,5%) presented 137 Hypermotor PNES, followed by Aurain 36p (68%) presenting 53 PNES. The Total lack of Responsiveness type waspresent in 15p (28.3%) with 32 PNES, and Motionless type in 11p (20,7%) with 20PNES. Conclusion: VEEG is the study of choice for the diagnosis of PNES, sinceit is a dependent operator study, defining the semiological features of PNESresults in a most precise diagnosis. In our study we found that most of thepatients presented with multiple crisis with non-stereotyped events. The mostfrequent clinical presentation was hypermotor PNES. Thoroughly observation ofVEEG recordings by trained personal is essential to accomplish an accuratediagnosis of PNES.