Christos Lambrakis M.D.

Northeast Regional Epilepsy Group Christos Lambrakis M.D.

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September 20th, 2014

How is PNES Diagnosed with Video-EEG

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PNES • Non-epileptic seizures are episodes that resemble epileptic seizures clinically but are not derived from electrical disturbances.

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Psychogenic Non-epileptic Seizures • Resemble epileptic seizures but lack EEG correlate.

• Very common (~25% of patients referred to Video-EEG monitoring for evaluation of intractable epilepsy). 4

Psychogenic Non-epileptic Seizures • Psychiatric manifestation – Somatoform/Conversion Disorder (most common) • Unconscious production of physical symptoms due to psychological factors

– Factitious Disorder • Consciously determined symptoms driven by a powerful unconsciously determined need.

– Malingering • Willful production of symptoms for a specific external incentive. 5

Psychogenic Non-epileptic Seizures • Often difficult to distinguish clinically from epileptic seizures. • Clues: – Resistance to AEDs – Emotional Triggers (stress) – Bilateral clonic movements without loss of consciousness – Absence of post-event confusion/lethargy.

• Video-EEG is very helpful in diagnosis.

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Electroencephalogram (EEG)

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Electroencephalogram EEG • Represents a record of the small shifting brain electrical potentials from the surface of the brain recorded over the scalp. • As seizures are caused by a disturbance of electrical activity, the EEG is uniquely suited to further our understanding of a patients seizures.

Goals of Video-EEG Monitoring • Is it really an epileptic seizure? (Epilepsy vs. non-epileptic events) • What type of seizure is it? (Characterize epilepsy type) • Where does the seizure originate from? Is it focal? (i.e. does it come from one specific region?)

Electrodes

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Inpatient Video-EEG

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Outpatient Ambulatory VideoEEG

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Routine EEG • Short duration (