E-Pearl of the Week: Oy-sters in Psychogenic Non-epileptic Seizure Diagnosis

March 29, 2011


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March 28, 2011

Oy-sters in psychogenic non-epileptic seizure diagnosis

The gold standard for diagnosis of psychogenic non-epileptic seizures (PNES) is video electroencephalography (EEG). Certain clinical signs are associated with PNES but may not reliably distinguish PNES from epileptic seizures:

  1. Pelvic thrusting: this sign cannot reliably distinguish PNES from frontal lobe epilepsy.
  2. Ictal eye closure: while a finding of prolonged eye closure (>55% of spell duration) on video EEG is specific to PNES, witness observation or self-report of prolonged ictal eye closure have not been proven to be useful.

It is also important to remember that subtle simple partial seizures can be missed on surface electrode EEG recording, and this possibility must always be considered when PNES is suspected.


  1. Hoerth MT, Wellik KE, Demaerschalk BM, et al. Clinical predictors of psychogenic nonepileptic seizures: a critically appraised topic. Neurologist 2008; 14: 266-270.

Submitted by:
Victoria S. S. Wong, MD

Disclosure: Dr. Wong serves on the editorial team for the Neurology® Resident and Fellow Section.

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