Ictal characteristics of psychogenic nonepileptic seizures: what we have learned from video/EEG recordings - a literature review.

Psychogenic nonepileptic seizures (PNES) are highly prevalent in selected populations, with a strong impact in terms of morbidity and social cost. The gold standard for PNES diagnosis is video/EEG recording of a typical attack. However this technique is costly and not always available. In addition, many patients are treated with antiepileptic drugs for several years before undergoing video/EEG recording. The diagnosis is further complicated by concomitant epileptic seizures in some patients with PNES. Therefore, a good knowledge of PNES semiology is important for early screening of patients for video/EEG recording and for correct interpretation of the examination. We reviewed the literature on video/EEG studies reporting ictal PNES semiology to identify features indicative of psychogenic or epileptic seizures. Several features appeared to be useful in the clinical setting.