Clues to suspect PNES prior to video-EEG monitoring

Publish Year: 1397
نوع سند: مقاله کنفرانسی
زبان: English
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EPILEPSEMED15_084

تاریخ نمایه سازی: 29 اردیبهشت 1398

Abstract:

It is well known that at least one-tenth of the patients seen in general practice by neurologists and up to one-fifth of those who visit an epilepsy center with suspected epilepsy should actually be diagnosed as psychogenic non-epileptic seizure (PNES). Although ictal recording of suspected seizures is widely accepted as the gold standard for definitive diagnosis of PNES, that is not practical when the seizures occur only once a week or less frequently, even when access to video-EEG simultaneous recording is widely available. Although use of a single sign for diagnosis of PNES can be misleading, some combinations of multiple signs are highly indicative of the condition. In this lecture, frequently seen presentations in PNES patients are presented and rated based on challenge level with regard to tentative diagnosis prior to ictal recording. It is important to note that the level of evidence is typically low. Suspected PNES based solely on history-taking requires continuous reappraisals in view of the response to ensuing therapeutic intervention as well as videos later provided by family members. In this regard, the following manifestations will be discussed. A) Continual extremity jerking A-1) Shaking arms in an upright position A-2) Shaking the head side to side without falling A-3) Jerking after falling down (syncopal attacks must be excluded prior to suspicion of PNES) A-4) Prolonged tonic posturing of the whole body or body parts B) Sudden falling without convulsions B-1) Prolonged astasia-abasia, paralysis, or aphonia after falling B-2) Prolonged impaired consciousness (including sleep) after falling B-3) Falling without notable accompanying signs (PNES can be suspected after cautious exclusion of other possibilities) C) Impaired consciousness without either sudden falling or convulsions C-1) Prolonged state of akinetic mutism (eyes closed) C-2) Prolonged state of akinetic mutism (eyes open) (PNES can only be suspected after video-EEG monitoring) C-3) Paroxysmal amnesia (PNES can be suspected after cautious exclusion of other possibilities) C-4) Episodic appearance of childish personality with simultaneous amnesia regarding those episodes .

Authors

Kousuke Kanemoto

Ph.D. Kyoto University, Kyoto, Japan