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November 19, 2015: Eye and Facial Findings in Psychogenic Nonepileptic Seizures (PNES)

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November 19, 2015

Eye and Facial Findings in Psychogenic Nonepileptic Seizures (PNES)

Clinically differentiating psychogenic nonepileptic seizures (PNES) from frontal lobe epilepsy can be challenging, but some facial findings may be helpful. Eye closure and longer duration of eye closure during seizure are seen in PNES as opposed to epileptic seizures (ES) where the eyes are usually open at onset. Patients commonly resist lid opening and retain the pupillary light reflex in PNES. The pupillary reflex is lost in ES. Patients with PNES may exhibit geotropic eye movements: the eyes deviate downward in the direction that the head is turned. Mouth closure in the tonic phase is seen with PNES and is very rare in ES. Video-recorded eye closure has been reported as having a sensitivity of 92% and specificity of 64% for PNES. None of these findings are diagnostic and EEG is required for confirmation.

  1. LaFrance WC Jr, Benbadis SR. Differentiating frontal lobe epilepsy from psychogenic nonepileptic seizures. Neurol Clin. 2011; 29: 149-162.

Submitted by Zubeda Sheikh, MD, PGY-4, Department of Neurology, Rutgers- New Jersey Medical School.

Disclosures: Dr. Sheikh reports no disclosures.

For more clinical pearls and other articles of interest to neurology trainees, visit Neurology. Listen to this week's Neurology Podcast.

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