P01-389 - Psychogenic Non-epileptic Seizures: Clinical Classification Based on the Video-EEG Analysis of 145 Seizures

Abstract

The “psychogenic non-epileptic seizures (PNES), paroxysmal behavioral changes that resemble an epileptic seizure but are not associated with electrophysiological epileptic changes seem to be caused by a psychological process. They still are misdiagnosed. The video-EEG allows their direct observation.

After studying the characteristics of the affected population, we have studied the semiological aspect of PNES and have sought to demonstrate inter and intra-individuals reproducibility who attest to common “laws” and would look a neurological substrate for these events.

We analyzed the symptomatology of 145 PNES, recorded by video-EEG in 52 patients. Statistical analysis of data consisted first, to describe the characteristics of seizures and patients. Secondly, we conducted a multiple correspondence analysis and hierarchical clustering. The SAS ® v9.1 was used.

Results

5 subtypes of PNES emerged from the statistical analysis showing reproducibility of seizures in 61.54% of patients:

1. - brief crisis with automatisms and dystonia

2. - “pauci-kinetic”, sensitive crisis with preserved contact

3. - brief and brutal crisis with break contact and clonic jerks

4. - “major crisis” with extended axial spasms

5. - prolonged, fluctuating with hyperventilation preceded by prodrome.

The identification of a typology can move from a clinical based diagnosis to a real positive diagnosis. The reproducibility of the crisis allow to make common pathophysiological hypotheses. The history of psychological trauma query on a relationship between the management of neuro-psychological affects and PNES “dysfunction” of connections between the frontal lobe, the limbic system and the basal ganglia. Beyond the positive diagnosis, the fundamental and therapeutic perspectives are many.