The International League Against Epilepsy defines psychogenic nonepileptic seizures (PNESs) as attacks that superficially mimic epileptic seizures but without any electrophysiological evidence of abnormal neuronal activity(1). PNESs are considered Experiential and behavioral responses to triggers , either external or internal , that resembles epileptic seizures but are neither associated with epileptic discharges in the electroencephalogram (EEG) nor other readily identifiable pathophysiological changes(2).
PNES does not finds home either in psychology or in medical settings because of its pseudo neurological and psychological features, and thus, management of PNES, remains a challenge because it involves combined effort of psychologist, psychiatrist, and neurologist(3)
The epidemiology of dual diagnosis of epilepsy and PNES is considerably uncertain ; actively comorbid epilepsy has been reported in 6%to 60% of patients with PNES.(4,5)
Patients with PNES were found to have high rates of comorbid psychiatric disorders, with nearly all patients with PNES having at least one current additional psychiatric disorder. The comorbidities may act as precipitator or triggers of PNES or may coexist without such a direct relation.(4)
For an accurate diagnosis to be reached both , meticulous history taking with episodes semiology coherent with the characteristic features of PNES, and video-EEG recording lacks epileptiform activity in all the stages (i.e., immediately before, during or after the ictal event) are required. (6)