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Psychogenic nonepileptic seizures

Paul Garcia, MD
Section Editor
Timothy A Pedley, MD
Deputy Editor
Janet L Wilterdink, MD


Clinicians are regularly challenged to identify the nature of episodic neurologic symptoms. Events associated with prominent motor activity or altered consciousness are often presumed to be epileptic seizures. However, the event may actually represent one of a wide array of nonepileptic paroxysmal events, such as syncope, parasomnias, movement disorders, and psychogenic nonepileptic seizures (PNES) (table 1).

PNES are characterized by sudden and time-limited disturbances of motor, sensory, autonomic, cognitive, and/or emotional functions that can mimic epileptic seizures. However, in contrast to epileptic seizures, PNES are not associated with physiological central nervous system dysfunction but are instead psychogenically determined. Historical terms for PNES, including pseudoseizures and hysterical seizures, are now discouraged.

It is important that clinicians consider PNES when evaluating patients with episodic symptoms. Missing this diagnosis may result in inappropriate treatment with antiseizure drugs that are associated with potential morbidity, especially if drug toxicity is incurred in the attempt to suppress episodes. While video-electroencephalography (EEG) has greatly advanced our ability to recognize PNES, an accurate diagnosis is best achieved by assimilating a wide variety of clues, including a detailed history from the patient and observers, the physical examination, selected testing, and a psychiatric evaluation.

The epidemiology, clinical features, diagnosis, and treatment of PNES are discussed here. Other nonepileptic paroxysmal disorders are discussed separately. (See "Nonepileptic paroxysmal disorders in adolescents and adults".)


Incidence rates of PNES in the general population are not well established. One epidemiologic study in Iceland reported an incidence rate of 1.4 per 100,000 individuals over age 15 years; a study in Ohio documented a mean incidence of 3 per 100,000 between 1995 and 1998 [1-3]. The prevalence of PNES has been estimated to be between 2 to 33 per 100,000 [4].

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Literature review current through: Sep 2017. | This topic last updated: Sep 06, 2017.
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