Psychogenic nonepileptic seizures and psychogenic
                    movement disorders: two sides of the same coin?

Paola, Luciano De; Marchetti, Renato L.; Teive, Hélio Afonso Ghizoni; LaFrance-Jr., W. Curt

doi:10.1590/0004-282X20140111

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Views and Reviews • Arq. Neuro-Psiquiatr. 72 (10) • Oct 2014 • https://doi.org/10.1590/0004-282X20140111 linkcopy

Psychogenic nonepileptic seizures and psychogenic movement disorders: two sides of the same coin?

Crises não-epilépticas psicogênicas e distúrbios do movimento psicogênicos: dois lados da mesma moeda?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstracts

Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are commonly seen in Neurology practice and are categorized in the DSM-5 as functional neurological disorders/conversion disorders. This review encompasses historical and epidemiological data, clinical aspects, diagnostic criteria, treatment and prognosis of these rather challenging and often neglected patients. As a group they have puzzled generations of neurologists and psychiatrists and in some ways continue to do so, perhaps embodying and justifying the ultimate and necessary link between these specialties.

psychogenic nonepileptic seizures; psychogenic movement disorders; conversion disorder; hysteria

	History	Witnessed event (semiology)	and EEG
Diagnostic level
Possible	+	By witness or self-report/description	No epileptiform activity in routine or sleep deprived interictal EEG
Probable	+	By clinician who reviewed video recording or in person, showing typical semiology of PNES	No epileptiform activity in routine or sleep deprived interictal EEG
Clinically established	+	By clinician experienced in diagnosis of seizure disorders (on video or in person), showing typical semiology of PNES, while not on EEG	No epileptiform activity in routine or ambulatory ictal EEG during a typical ictus/event in which the semiology would make ictalepileptiform EEG activity expectable during equivalent epileptic seizures
Documented	+	By clinician experienced in diagnosis of seizure disorders, showing typical semiology of PNES, while on video EEG	No epileptiform activity immediately before, during or after ictus captured on ictal Video EEG with typical PNES semiology

PMD	n (%)
Tremor	42 (50.6)
Dystonia	27 (32.5)
Gait disorder	13 (15.6)
Others	8 (9.6)
Parkinsonism	7 (8.4)
Myoclonus	4 (5)
Cerebellar ataxia	3 (4.16)
Tics	0 (0)
Total	83 (100)

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[1] Key: “+”: History characteristics consistent with PNES. EEG: Electroencephalogram.(As noted in the text, additional tests may affect the certainty of the diagnosis – for instance, self-protective maneuvers or forced eye closure during unresponsiveness or normal postictal prolactin levels with convulsive seizures).