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Overview of proposed diagnostic levels of certainty for psychogenic nonepileptic seizures (PNES)*

Overview of proposed diagnostic levels of certainty for psychogenic nonepileptic seizures (PNES)*
  History Witnessed event EEG
Diagnostic level
Possible History characteristics consistent with PNES By witness or self-report/description No epileptiform activity in routine or sleep-deprived interictal EEG
Probable History characteristics consistent with PNES By clinician who reviewed video recording or in person, showing semiology typical of PNES No epileptiform activity in routine or sleep-deprived interictal EEG
Clinically established History characteristics consistent with PNES By clinician experienced in diagnosis of seizure disorders (on video or in person), showing semiology typical of PNES, while not on EEG No epileptiform activity in routine or ambulatory ictal EEG during a typical ictus/event in which the semiology would make ictal epileptiform EEG activity expectable during equivalent epileptic seizures
Documented History characteristics consistent with PNES By clinician experienced in diagnosis of seizure disorders, showing semiology typical of PNES, while on video EEG No epileptiform activity immediately before, during, or after ictus captured on ictal video EEG with typical PNES semiology
EEG: electroencephalography.
* Additional tests may affect the certainty of the diagnosis (eg, self-protective maneuvers or forced eye closure during unresponsiveness or normal postictal prolactin levels after convulsive seizures).
From: LaFrance WC Jr, Baker GA, Duncan R, et al. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: A staged approach: A report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia 2013; 54(11):2005-18. https://onlinelibrary.wiley.com/doi/abs/10.1111/epi.12356. Copyright © 2013 The International League Against Epilepsy. Reproduced with permission of John Wiley & Sons Inc. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: permissions@wiley.com or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (http://onlinelibrary.wiley.com).
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