Classification and comparative analysis of psychogenic nonepileptic seizures (PNES) semiology based on video-electroencephalography (VEEG)

Background: Multiple classification systems for psychogenic nonepileptic seizures (PNES) based on semiological features have been described. We sought to compare the efficiency of four PNES classification systems. Methods: We retrospectively analyzed medical and video-electroencephalography (VEEG) records of patients with PNES with at least one typical event recorded on VEEG. Semiology of PNES events was stringently classified using Hubsch, Dhiman, Wadwekar, and Asadi-Pooya's classification systems. Results: We studied 248 patients with PNES (78% females, mean age 23.1 +/- 10.3 years) and reviewed 498 PNES events. Using Hubsch's scheme, we classified events into: dystonic attacks with primitive gestural activity (5.2%), paucikinetic attacks with preserved responsiveness (9.7%), pseudosyncope (59.8%), hyperkinetic prolonged attacks (16.2%) and axial dystonic prolonged attacks (1.6%), and unclassified (7.5%). Using Dhiman's classification, events were: abnormal motor (hypermotor [10.4%]/ partial motor [12.7%]), dialeptic type (58.6%), mixed patterns (17.3%), and unclassified (1%). Using Wadwekar's classification: dystonic attacks with primitive gestural activity (5.2%), paucikinetic attacks with preserved responsiveness (9.6%), pseudosyncope with/without hyperventilation (65.1%), hyperkinetic prolonged attacks involving limbs +/- trunk (18.5%), and axial dystonic prolonged attacks (1.6%). Using AsadiPooya's classification, events were: hypermotor (30.1%), non-motor (62.9%), and mixed (7.0%). All events could be classified via Wadwekar and Asadi-Pooya systems. Conclusion: In our study, pseudosyncope/dialeptic/non-motor semiology emerged as most frequent. Most of our patients with PNES had stereotyped semiology. All events could be classified using the schemes by Asadi-Pooya and Wadweker et al. Dhiman et al. scheme could classify 99% and 7.5% remained unclassified using Hubsch et al. scheme. (C) 2020 Published by Elsevier Inc.

Automated summary

This study compared the efficiency of four PNES classification systems and found that pseudosyncope/dialeptic/non-motor semiology was the most frequent. Most patients with PNES had stereotyped semiology. All events could be classified using the schemes by Asadi-Pooya and Wadweker et al.