Abstract
Objective Only a few studies have compared the different classification systems of psychogenic
nonepileptic seizures (PNESs). A universally acceptable classification system for
PNES will aid in the early diagnosis and may lead to better standardization for future
studies. This study aimed to describe the clinical semiology and provide comparative
analysis of PNES classification systems described by Hubsch et al, Wadwekar et al,
Dhiman et al, and Asadi-Pooya.
Methods Prospectively, patients provisionally diagnosed clinically as PNES were confirmed
on video electroencephalography and their semiology was classified according to the
classification systems mentioned earlier. Patients were additionally evaluated for
coexisting anxiety or depression using Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition criteria and its severity assessed using Hamilton's depression/anxiety
rating scales.
Results A total of 104 PNES patients were included in the study. Mean age at presentation
was 24.5 ± 10.4 years with females as the predominant proportion (76.9%). Whole body
flaccidity was the commonest clinical presentation of PNES seen in 60.58% cases. All
PNES cases could be classified using the Asadi-Pooya's classification, while 8.7,
47.1, and 53.8% PNES events remained unclassified, respectively, using the classification
system as described by Dhiman et al, Wadwekar et al, and Hubsch et al; 33(31.73%)
PNES patients had depression and 8 (7.7%) had generalized anxiety disorder in our
study.
Conclusion Nonmotor manifestations were the most frequent semiology in our cohort. Of the PNES
classification systems studied, Asadi-Pooya's classification was easier to apply and
could classify all the patients in the study.
Keywords
psychogenic - nonepileptic - seizures
