| Preparation |
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Obtain written consent for procedure, recording, data storage (including for suggestion procedures if relevant)
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Begin video recording as soon as consent has been obtained
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Record detailed description of seizure semiology from patient (witnesses if available)
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| Suggestion |
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Discussion of seizure symptoms can have suggestive effect (draws attention to symptoms)
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Consider whether suggestion procedures required/ethical in patient’s individual circumstances
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No benefit to explicit deception
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Assess typicality of any captured attack in a standardized way
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| Ictal observation |
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Narrating subtle clinical signs can help with reporting and may have suggestive effects
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If consciousness appears impaired, test awareness (e.g. “Stick your tongue out”) and subsequent recall (e.g. “Remember the word flower”)
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Consider bedside tests of avoidance (e.g. resistance to eye opening)
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| Verification |
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Carefully compare manifestations of seizures captured with semiological details obtained during history-taking
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If seizure captured: ask patient whether seizure typical of habitual attacks
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If seizure captured: check with witnesses (if available) if seizure typical
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| EEG report |
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Consider a standardised format
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Begin with up-to-date clinical history of all attack types, e.g. Type 1, Type 2
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Detailed description of any attacks captured, e.g. ‘Type 1: xxx’
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Clearly distinguish epileptiform and non-epileptiform abnormalities in the report
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Provide specific time points (e.g. 10:01:26), markers or screenshots of important features to allow subsequent review
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Emphasise information which strengthens or weakens likelihood of PNES
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Comment on interictal EEG, as well as EEG immediately before, during and after an attack
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Comment on presence or absence of ictal ECG or other polygraphic changes
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Explicitly state if alpha present, or if this could not be assessed (artifact)
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| Archiving |
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