Identifying Epilepsy and PNES Conditions

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Questions and Answers

What is the primary method for distinguishing between PNES and epileptic seizures?

Relation to medication changes

Emotional disturbances

Interictal EEG findings

EEG-video monitoring (correct)

What is a common feature of postictal headaches in epileptic seizures compared to PNES?

They are rare in epileptic seizures (correct)

They are equally common in both

They are less common in epileptic seizures

They are more common in PNES

What is a characteristic of triggers in PNES?

They are usually related to medication changes

They are often emotional disturbances

They are always related to sleep deprivation

They are unrelated to medication changes (correct)

What is a difference in the frequency of attacks between PNES and epileptic seizures?

PNES attacks can occur daily Signup and view all the answers

What is a characteristic of interictal EEG findings in PNES?

They are always normal Signup and view all the answers

What is a characteristic of breath-holding spells in children?

They may occur as early as the first month of life Signup and view all the answers

What is a similarity between PNES and epileptic seizures in terms of reproduction of attacks?

Both can be reproduced by suggestion Signup and view all the answers

What is a difference in the relation to menses between PNES and epileptic seizures?

PNES are occasionally increased related to menses in women Signup and view all the answers

What is the primary focus of the initial evaluation of a patient with syncope?

Detailed history from the patient and any witnesses Signup and view all the answers

What is a characteristic feature of CNS myelination deficiency in infants?

More migratory jerking rather than synchronous jerking Signup and view all the answers

What is a potential indication of an arteriovenous malformation in a patient with seizures?

Cranial bruits Signup and view all the answers

In which age group is mental retardation associated with birth injury or metabolic defects?

Pediatric age group Signup and view all the answers

What is a recommended diagnostic test for all patients with syncope?

ECG to rule out cardiac conditions Signup and view all the answers

What should be examined in a patient with suspected neurodegenerative disorders?

Skin for abnormal pigment changes and other dysmorphic features Signup and view all the answers

What is the primary goal of limited laboratory testing in the acute setting of a patient with syncope?

To rule out anemia and hypoglycemia Signup and view all the answers

When is imaging and laboratory testing not necessary in a patient with syncope?

When the history and physical are highly suggestive of vasovagal syncope and the exam and ECG show no concerning findings Signup and view all the answers

What is the primary cause of syncope in children and young adults?

Hyperventilation or vasovagal attacks Signup and view all the answers

Which of the following is a common cause of syncope in young females?

Basilar migraine Signup and view all the answers

What is the term used to describe a temporary sinus pause or bradycardia?

Reflex arrhythmias Signup and view all the answers

Which of the following is NOT a type of arrhythmia that can cause syncope?

Vasovagal attacks Signup and view all the answers

What is the primary diagnostic tool used in the initial evaluation of syncope?

History and physical examination Signup and view all the answers

Which of the following is a common cause of decreased cardiac output, leading to syncope?

Outflow obstruction Signup and view all the answers

Which age group is more likely to experience syncope due to congenital heart disease?

Children and young adults Signup and view all the answers

What is the term used to describe fainting associated with benign tachycardias without underlying organic heart disease?

Syncope Signup and view all the answers

What is the primary goal of evaluating and managing patients with syncope?

To guide the clinician in the care of these patients Signup and view all the answers

What should the neurologist search for during an examination immediately after a suspected tonic-clonic seizure?

Abnormal signs such as focal motor weakness and reflex asymmetry Signup and view all the answers

What is the distinguishing feature of generalized epilepsies?

Seizures that involve both hemispheres at onset Signup and view all the answers

What is the term used to describe the clinical manifestation of a seizure?

Semiology Signup and view all the answers

What is the definition of epilepsy?

The syndrome of recurrent unprovoked seizures Signup and view all the answers

What is the basis for seizure classification?

Functional distribution and structural neuroanatomy of the brain Signup and view all the answers

What is the term used to describe the temporary weakness of a limb after a seizure?

Todd paralysis Signup and view all the answers

What is the primary difference between seizures and syncope?

Seizures are clinically distinguishable from syncope Signup and view all the answers

What is a characteristic of a patient experiencing a psychogenic pseudosyncope?

Apparent loss of consciousness for a longer duration than in syncope Signup and view all the answers

What is the purpose of tilt-table testing in diagnosing psychogenic seizures?

To document a decrease in heart rate or blood pressure Signup and view all the answers

What is a common finding in patients with clinically documented seizures?

Normal EEG readings Signup and view all the answers

What should be considered in a patient with known epilepsy who experiences medically refractory seizures?

Psychogenic seizures Signup and view all the answers

What is a characteristic of a patient experiencing a seizure during an EEG recording?

Absence of clinical event during the recording Signup and view all the answers

What is a common comorbidity found in patients with psychogenic seizures?

Specific psychiatric disturbances Signup and view all the answers

What can be used to distinguish psychogenic seizures from epilepsy?

Psychological assessments Signup and view all the answers

What is a limitation of EEG in diagnosing epilepsy?

EEG cannot confirm epilepsy with certainty Signup and view all the answers

Study Notes

Diagnosis of PNES and Epileptic Seizures

During and immediately after the spell, the patient may not respond to verbal or painful stimuli, but cyanosis does not occur, and focal neurological signs and pathological reflexes are absent.
EEG cannot confirm the diagnosis with certainty unless the patient has a clinical event during the recording.
Normal findings on the EEG do not exclude epilepsy, and minor nonspecific abnormalities do not confirm epilepsy.
Some patients with clinically documented seizures show no abnormality even after serial or prolonged EEG recordings, including with special activation techniques.
PNES syncope without prominent motor activity can resemble epilepsy, and the apparent loss of consciousness in these patients may be longer than in syncope.

Distinguishing Features of PNES and Epileptic Seizures

PNES can be distinguished from syncope if tilt-table testing fails to document a decrease in heart rate or blood pressure.
In the patient with known epilepsy, consider the diagnosis of nonepileptic spells when previously controlled seizures become medically refractory.
Postictal headache is rare in PNES, but common in epileptic seizures.
Postictal crying is common in PNES, but rare in epileptic seizures.
Relation to medication changes, relation to menses, and frequency of attacks can also be used to distinguish between PNES and epileptic seizures.

EEG-Video Monitoring

EEG-video monitoring is the standard diagnostic method for distinguishing between PNES and epileptic seizures.
No procedure attains the reliability of EEG-video monitoring.

Miscellaneous Causes of Altered Consciousness

In children, alteration of consciousness may accompany breath-holding spells and metabolic disturbances.
Breath-holding spells and seizures are easily distinguished, and most spells start at 6–28 months of age, but may occur as early as the first month of life; they usually disappear by 5 or 6 years of age.

Syncope

The history and physical examination are the most important components of the initial evaluation of syncope.
Significant age and sex differences exist in the frequency of the various types of syncope.
Arrhythmias, decreased cardiac output, and outflow obstruction can cause syncope.
In summary, the initial and most important parts of the evaluation of a patient with syncope are a detailed history from the patient and any witnesses of the syncopal event, followed by a thorough physical examination.

Seizures

Seizures can cause sudden, unexplained loss of consciousness in a child or an adult.
Seizure classification is based on their functional distribution and on the structural neuroanatomy of the brain.
Generalized epilepsies are characterized by seizures that involve both hemispheres at onset rather than by electrographic spread.

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Description

This quiz covers the differences between epilepsy and psychogenic non-epileptic seizures (PNES) based on clinical events and EEG results.