Clinical Semiology and Comparative Analysis of Different Classification Systems of Psychogenic Nonepileptic Seizures

Abstract

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.