Descriptive Analysis of the Posture and Movement in Psychogenic Non-Epileptic Seizures (P02.168)

Abstract

Objective: To describe the head, trunk, and limb posture and movement of PNES. Background Video EEG monitoring is the gold standard study for the diagnosis of epileptic seizures (ES) from psychogenic non-epileptic seizures (PNES). It has been observed that PNES have distinct head, body, and limb posture or movement that are different from ES. There is a need to describe the semiology of PNES in order to help physicians to differentiate non-epileptic and epileptic motor seizures. Design/Methods: 148 video EEGs in 55 adult PNES patients were retrospectively reviewed and analyzed by the investigators. A minimum of 1 and a maximum of 3 videos of a typical seizure per patient were analyzed. The head, body and limbs were described in terms of their posture, movement and synchronicity. Results: Seventy percent (70%) of the patients was female and were between 18-45 years of age. Bilateral flexion and adduction was a common upper limb posture. Open hand, claw or thumbs up formation were common hand postures (bilateral/unilateral). Bilateral or unilateral flexion-extension at the shoulder or elbow was the common movement seen. Bilateral extension and adduction at the hips and knees was the most common lower limb posture. Flexion-extension or adduction-abduction at the hip and knee occurring unilaterally or bilaterally were the common lower limb movements. PNES patients were frequently observed to have a supine posture with their eyes close and their head in midline position and moving side to side. Pelvic thrusting, rocking movement or side to side truncal movement was seen commonly in decreasing frequency. Asynchronous, irregular and waxing waning character of limb movement was a regular feature. Conclusions: PNES have distinct head, body and limb postures and movements. This will be useful in the diagnosis of PNES. Disclosure: Dr. Lardizabal has received personal compensation for activities with UCB Pharmaceuticals and Abbott Pharmaceutical as a speaker. Dr. Bahl has nothing to disclose. Dr. Lanigar has nothing to disclose. Dr. Sahota has nothing to disclose.