Red flags for PNES

  1. Home
  2. Red flags for PNES
  • Characteristic motor phenomenon [better seen with video EEG]
    • very gradual onset or termination
    • discontinuous (stop and go), irregular, or asynchronous (out of phase) activity
    • side-to-side head movements
    • pelvic thrusting
    • opisthotonic posturing
    • stuttering
    • weeping
    • preserved awareness during bilateral motor activity [may also occur in frontal lobe seizures]
    • persistent eye closure
  • Resistance to AEDs
  • High frequency of seizures [multiple daily episodes] that are not affected by AEDs
  • Triggers unsual for epilepsy [stress, anger, pain, certain movments, sounds], esp. if consistent
  • Occuring in presence of a audience
  • Do not occur during sleep
  • Florid review of systems, given diagnosis of somatization, fibromyalgia or chornic pain
  • Positive Psychosocial history
  • Normal EEGs, especially in light of frequent attacks and resistance
    to medications, certainly can be viewed as a ‘‘mild” red flag
  • histrionic behaviors
  • give-away weakness
  • tight roping
  • an attack during examination esp. by suggestion