Early recognition of psychogenic nonepileptic seizures: Differential diagnosis of paroxysmal events

Abstract

When dissociative seizures, also known as psychogenic, nonepileptic seizures, are misinterpreted as epileptic seizures, this leads to unsuccessful drug treatment and initiation of the necessary psychotherapy is delayed. The following seizure symptoms strongly suggest dissociative seizures: nonrhythmic, wild back and forth movements of the head or extremities, closed eyes, long duration and an undulating course. An inconspicuous electroencephalogram (EEG) is suggestive of dissociative seizures but only a negative EEG result during a seizure is conclusive. In the medical consultation it is decisive that patients have the opportunity to freely describe the symptoms. Patients with dissociative seizures show peculiarities that should be used as diagnostic criteria: They focus on accompanying circumstances and leave out the moment of loss of consciousness in their descriptions. They give more general information and hardly differentiate between individual seizures.