Podcast
Questions and Answers
What is the primary method for distinguishing between PNES and epileptic seizures?
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?
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?
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?
What is a difference in the frequency of attacks between PNES and epileptic seizures?
What is a characteristic of interictal EEG findings in PNES?
What is a characteristic of interictal EEG findings in PNES?
What is a characteristic of breath-holding spells in children?
What is a characteristic of breath-holding spells in children?
What is a similarity between PNES and epileptic seizures in terms of reproduction of attacks?
What is a similarity between PNES and epileptic seizures in terms of reproduction of attacks?
What is a difference in the relation to menses between PNES and epileptic seizures?
What is a difference in the relation to menses between PNES and epileptic seizures?
What is the primary focus of the initial evaluation of a patient with syncope?
What is the primary focus of the initial evaluation of a patient with syncope?
What is a characteristic feature of CNS myelination deficiency in infants?
What is a characteristic feature of CNS myelination deficiency in infants?
What is a potential indication of an arteriovenous malformation in a patient with seizures?
What is a potential indication of an arteriovenous malformation in a patient with seizures?
In which age group is mental retardation associated with birth injury or metabolic defects?
In which age group is mental retardation associated with birth injury or metabolic defects?
What is a recommended diagnostic test for all patients with syncope?
What is a recommended diagnostic test for all patients with syncope?
What should be examined in a patient with suspected neurodegenerative disorders?
What should be examined in a patient with suspected neurodegenerative disorders?
What is the primary goal of limited laboratory testing in the acute setting of a patient with syncope?
What is the primary goal of limited laboratory testing in the acute setting of a patient with syncope?
When is imaging and laboratory testing not necessary in a patient with syncope?
When is imaging and laboratory testing not necessary in a patient with syncope?
What is the primary cause of syncope in children and young adults?
What is the primary cause of syncope in children and young adults?
Which of the following is a common cause of syncope in young females?
Which of the following is a common cause of syncope in young females?
What is the term used to describe a temporary sinus pause or bradycardia?
What is the term used to describe a temporary sinus pause or bradycardia?
Which of the following is NOT a type of arrhythmia that can cause syncope?
Which of the following is NOT a type of arrhythmia that can cause syncope?
What is the primary diagnostic tool used in the initial evaluation of syncope?
What is the primary diagnostic tool used in the initial evaluation of syncope?
Which of the following is a common cause of decreased cardiac output, leading to syncope?
Which of the following is a common cause of decreased cardiac output, leading to syncope?
Which age group is more likely to experience syncope due to congenital heart disease?
Which age group is more likely to experience syncope due to congenital heart disease?
What is the term used to describe fainting associated with benign tachycardias without underlying organic heart disease?
What is the term used to describe fainting associated with benign tachycardias without underlying organic heart disease?
What is the primary goal of evaluating and managing patients with syncope?
What is the primary goal of evaluating and managing patients with syncope?
What should the neurologist search for during an examination immediately after a suspected tonic-clonic seizure?
What should the neurologist search for during an examination immediately after a suspected tonic-clonic seizure?
What is the distinguishing feature of generalized epilepsies?
What is the distinguishing feature of generalized epilepsies?
What is the term used to describe the clinical manifestation of a seizure?
What is the term used to describe the clinical manifestation of a seizure?
What is the definition of epilepsy?
What is the definition of epilepsy?
What is the basis for seizure classification?
What is the basis for seizure classification?
What is the term used to describe the temporary weakness of a limb after a seizure?
What is the term used to describe the temporary weakness of a limb after a seizure?
What is the primary difference between seizures and syncope?
What is the primary difference between seizures and syncope?
What is a characteristic of a patient experiencing a psychogenic pseudosyncope?
What is a characteristic of a patient experiencing a psychogenic pseudosyncope?
What is the purpose of tilt-table testing in diagnosing psychogenic seizures?
What is the purpose of tilt-table testing in diagnosing psychogenic seizures?
What is a common finding in patients with clinically documented seizures?
What is a common finding in patients with clinically documented seizures?
What should be considered in a patient with known epilepsy who experiences medically refractory seizures?
What should be considered in a patient with known epilepsy who experiences medically refractory seizures?
What is a characteristic of a patient experiencing a seizure during an EEG recording?
What is a characteristic of a patient experiencing a seizure during an EEG recording?
What is a common comorbidity found in patients with psychogenic seizures?
What is a common comorbidity found in patients with psychogenic seizures?
What can be used to distinguish psychogenic seizures from epilepsy?
What can be used to distinguish psychogenic seizures from epilepsy?
What is a limitation of EEG in diagnosing epilepsy?
What is a limitation of EEG in diagnosing epilepsy?
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.
