Podcast 650: PNES

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By medicalminute and Emergency Medical Minute. Discovered by Player FM and our community — copyright is owned by the publisher, not Player FM, and audio is streamed directly from their servers. Hit the Subscribe button to track updates in Player FM, or paste the feed URL into other podcast apps.

Contributor: Katie Sprinkel, MD

Educational Pearls:

  • Psychogenic Non-Epileptic Seizures (PNES) are due to a psychogenic rather than an epileptic cause
  • Despite common assumption, PNES are not always volitional
  • 20-40% of those with PNES can also have true epileptic seizures 20-40%
  • True diagnosis requires a video EEG
  • Characteristics of PNES include:
    • Waxing and waning of the seizure intensity
    • Eyes clenched shut
    • Pelvic thrusting, rolling from side-to-side
    • Ability to respond to verbal stimuli during the seizure
    • Ability to recall information during the seizure
    • Weeping or stuttering
    • Guarding the face on passive hand drop
  • Characteristics of epileptic seizures:
    • Tongue biting
    • Prolonged postictal state
    • Incontinence
  • Haldol or Zyprexa may be better for PNES and benzodiazepines tend to be better for epileptic seizures

References

Huff JS, Murr N. Psychogenic Nonepileptic Seizures. 2021 Jan 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 28722901.

Asadi-Pooya AA. Psychogenic nonepileptic seizures: a concise review. Neurol Sci. 2017 Jun;38(6):935-940. doi: 10.1007/s10072-017-2887-8. Epub 2017 Mar 8. PMID: 28275874.

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

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