Paroxysmal Nonepileptic Events

Abstract

Paroxysmal nonepileptic events are time-limited behavioral, cognitive, motor, sensory, and/or vegetative alterations, which, unlike epilepsy, do not depend on abnormal and excessive cortical activity. The two conditions posing the major issues of differential diagnosis with epilepsy are syncope and psychogenic seizures. The differential diagnosis relies on the clinical description or visual analysis of the episodes and on several tests and exams. Diagnostic criteria for psychogenic nonepileptic seizures rely on combinations of clinical and electroencephalographic features, and video-EEG monitoring is considered the “gold standard” investigation for these disturbances. Conversely EEG is not necessary for the diagnosis of syncope; however it shows some specific features that may be valuable for understanding the pathophysiology of the typical clinical signs of syncope. Electroclinical features of syncope and psychogenic nonepileptic seizure conditions are discussed.