Given the prevalence, clinical importance and challenges in diagnosis of Psychogenic Nonepileptic Seizures (PNES), we aimed to evaluate semiology and socioeconomic factors of patients with the diagnosis of PNES at our institution.

PNES are paroxysmal events with psychological etiology that are not associated with abnormal electrical activity in the brain. 

The VEEG reports of all patients 18 to 89-year-old admitted to the EMU at Upstate Medical University from October 2014 to July 2017 were reviewed. Patients with a discharge diagnosis of PNES were included and those with mixed epileptic and non-epileptic seizures were excluded from the study. Non-epileptic events, based on dominant semiology in each individual, were categorized as hypermotor (violent and disorganized movements of the extremities, pelvic thrusting, or head movements), hypomotor (altered responsiveness associated with either mild motor or trembling-like activities), or sensorium (subjective report of symptoms without impaired consciousness).

A total of 121 consecutive patients were included. Of the 498 recorded seizures, 50.4% were hypomotor, 36.4% hypermotor, and 13.2% sensorium. Mean number of events in sensorium group was significantly higher than motor-dominant groups (hypo and hypermotor combined) (5.7 ± 3.6 vs. 3.9 ± 3.2 respectively, p=0.04).  Semiological groups did not differ significantly in age (p=0.16) and gender (p=0.63). 31.8% of the patients had a family history of epilepsy and 88% reported anxiety or depression. PTSD and history of physical/sexual abuse were seen in 23.3% and 9.7% of patients, respectively, with no significant difference between semiological groups (p=0.61 and p=0.77).

Although sensorium group constituted a smaller proportion of our study group, they reported more events during the VEEG monitoring. Due to the subjectivity of these episodes, their reliability can be a challenging factor in the diagnosis of PNES. Most of the patients had a history of psychiatric disease such as anxiety, depression and PTSD.