What is the preferred method to diagnose psychogenic nonepileptic seizures?

What is the preferred method to diagnose psychogenic nonepileptic seizures?

• A. Routine EEG
• B. Video-EEG monitoring
• C. Brain MRI
• D. Serum autoimmune panels

Answer: (B)

Psychogenic nonepileptic seizures are events that look like epileptic seizures but do not arise from abnormal brain electrical activity. The way to confirm PNES is to capture an actual spell while recording brain activity and behavior at the same time. Video-EEG monitoring does just that: you observe the patient on video during a seizure-like event and simultaneously record their EEG. If the clinical spell occurs but the EEG shows no ictal epileptiform activity, you have objective evidence that the event is not epileptic in origin. This approach in an epilepsy monitoring unit provides the strongest, most definitive distinction between PNES and epilepsy. Routine EEGs can miss events because PNES episodes are intermittent, and a short recording may not capture one. Brain MRI looks for structural brain disease and autoimmune panels are used when autoimmune processes are suspected; neither is diagnostic for PNES. Thus, video-EEG monitoring uniquely correlates the clinical event with brain activity to confirm PNES.

Psychogenic nonepileptic seizures are events that look like epileptic seizures but do not arise from abnormal brain electrical activity. The way to confirm PNES is to capture an actual spell while recording brain activity and behavior at the same time. Video-EEG monitoring does just that: you observe the patient on video during a seizure-like event and simultaneously record their EEG. If the clinical spell occurs but the EEG shows no ictal epileptiform activity, you have objective evidence that the event is not epileptic in origin. This approach in an epilepsy monitoring unit provides the strongest, most definitive distinction between PNES and epilepsy.

Routine EEGs can miss events because PNES episodes are intermittent, and a short recording may not capture one. Brain MRI looks for structural brain disease and autoimmune panels are used when autoimmune processes are suspected; neither is diagnostic for PNES. Thus, video-EEG monitoring uniquely correlates the clinical event with brain activity to confirm PNES.