Table 1.
Differences in semiology and timing between PNES and epileptic seizures
| PNES | Epileptic seizure | |
|---|---|---|
| Timing | ||
| Directly induced by stress or confrontation | ++ | + |
| Waxes and wanes | ++ | - |
| Occurs in physician office | ++ | - |
| Worsens with witnesses in the room | ++ | - |
| Semiology | ||
| Crying | + | - |
| Whispering | + | - |
| Stuttering | + | - |
| Opisthotonic posture | + | - |
| Full body shaking with preserved awareness | ++ | - |
| Ictal cry | - | ++ (before GTC seizure) |
| Post-ictal buzz saw snore | - | ++ (after GTC seizure) |
| Eyes closed | ++ | - |
| Head/body/eye version | - | ++ (focal seizure) |
| Fencer’s posture | - | ++ (focal seizure) |
| Side-to-side head movement | + | - |
| Pelvic thrusting | + | + |
| Cyanosis | - | + (during GTC seizure) |
| Severe injury or trauma (burns and fractures) | - | + (during GTC seizure) |
Notes: ++ represents “frequent”, + represents “occasional”, and - represents “absent.”
Abbreviations: PNES, psychogenic nonepileptic seizures; GTC, generalized tonic-clonic.