BACKGROUND Psychogenic nonepileptic seizures (PNESs) are disruptive changes in behavior without ictal correlate of epileptic activity and high prevalence of psychiatric morbidity. Differential diagnosis is difficult particularly with temporal lobe epilepsy (TLE), which is also associated with high prevalence of psychiatric comorbidity. Although video electroencephalography is the gold standard for differential diagnosis, clinical semiology analysis may help the clinician in general medical practice. OBJECTIVE In this study, the differential semiology, based on video electroencephalography, between PNESs and TLE seizures was analyzed. METHODS The video electroencephalography of patients with diagnosis of PNES and TLE were reviewed and compared between groups. Clinical semiology of all episodes recorded by video electroencephalography in each patient was analyzed and classified in accordance with the presence of behavioral arrest, motor hyperkinetic activity, impaired awareness, aura, and automatisms. Chi square test and binary logistic regression were determined. RESULTS Thirty-two patients with PNES (32 ± 11 y) and 34 with TLE (32 ± 12 y) were included. Female patients were predominant in the PNES group (P < 0.05). Mean time duration of episodes was 6.8 ± 10 minutes in PNES and 1.6 ± 0.8 minutes in TLE (P < 0.05). Impaired awareness (odds ratio = 24.4; 95% confidence interval = 3.79 -157.3, P < 0.01), automatisms (odds ratio = 13.9; 95% confidence interval = 2.1- 90.5, P < 0.01), and shorter duration of the events (odds ratio = 2.261, 95% confidence interval = 1.149 - 4.449, P = 0.018) were found as independent factors for detecting TLE seizures comparing PNESs. CONCLUSION Clinical semiology analysis may orientate the differential diagnosis in general medical practice, between PNESs and TLE seizures. Further studies comparing PNES semiology with other subtypes of epilepsies may complete these preliminary findings.

中文翻译：

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基于 VEEG 监测的心因性非癫痫性癫痫发作与颞叶癫痫发作的差异符号学

背景 心因性非癫痫发作 (PNES) 是行为的破坏性变化，与癫痫活动和精神病发病率的高发病率无关。鉴别诊断尤其困难，尤其是颞叶癫痫 (TLE)，这也与精神疾病的高患病率有关。虽然视频脑电图是鉴别诊断的金标准，但临床符号学分析可能有助于临床医生在一般医疗实践中。目的 在本研究中，分析了基于视频脑电图的 PNES 和 TLE 癫痫发作之间的差异符号学。方法回顾并比较诊断为PNES和TLE患者的视频脑电图。对每位患者通过视频脑电图记录的所有发作的临床符号学进行分析，并根据是否存在行为停滞、运动过度活动、意识障碍、先兆和自动症进行分类。确定卡方检验和二元逻辑回归。结果 包括 32 名 PNES 患者（32 ± 11 岁）和 34 名 TLE 患者（32 ± 12 岁）。女性患者在 PNES 组中占主导地位（P < 0.05）。PNES 中发作的平均持续时间为 6.8 ± 10 分钟，TLE 中为 1.6 ± 0.8 分钟（P < 0.05）。意识受损（比值比 = 24.4；95% 置信区间 = 3.79 -157.3，P < 0.01）、自动症（比值比 = 13.9；95% 置信区间 = 2.1-90.5，P < 0.01）和事件持续时间较短（优势比 = 2.261，95% 置信区间 = 1.149 - 4.449，P = 0。018) 被发现作为检测 TLE 癫痫发作的独立因素，比较 PNES。结论 临床符号学分析可以确定普通医疗实践中 PNES 和 TLE 癫痫发作的鉴别诊断。将 PNES 符号学与其他癫痫亚型进行比较的进一步研究可能会完成这些初步发现。