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Emergency Medical Minute


Mar 22, 2021

Contributor:  Katie Sprinkel, MD

Educational Pearls:

  • Psychogenic Non-Epileptic Seizures (PNES) are due to a psychogenic rather than an epileptic cause
  • Despite common assumption, PNES are not always volitional 
  • 20-40% of those with PNES can also have true epileptic seizures 20-40%
  • True diagnosis requires a video EEG 
  • Characteristics of PNES include:
    • Waxing and waning of the seizure intensity
    • Eyes clenched shut
    • Pelvic thrusting, rolling from side-to-side
    • Ability to respond to verbal stimuli during the seizure 
    • Ability to recall information during the seizure
    • Weeping or stuttering
    • Guarding the face on passive hand drop
  • Characteristics of epileptic seizures:
    • Tongue biting
    • Prolonged postictal state
    • Incontinence
  • Haldol or Zyprexa may be better for PNES and benzodiazepines tend to be better for epileptic seizures


Huff JS, Murr N. Psychogenic Nonepileptic Seizures. 2021 Jan 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 28722901.

Asadi-Pooya AA. Psychogenic nonepileptic seizures: a concise review. Neurol Sci. 2017 Jun;38(6):935-940. doi: 10.1007/s10072-017-2887-8. Epub 2017 Mar 8. PMID: 28275874.


Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD