How variable are psychogenic nonepileptic seizures? A retrospective semiological study.

PURPOSE: To classify patients with psychogenic nonepileptic seizures (PNES) according to a recently proposed classification system and investigate the variability of PNES semiology. METHODS: We retrospectively investigated all patients with PNES admitted at the Jefferson Comprehensive Epilepsy Center from 2012 through 2016. We classified their seizures after retrospectively reviewing their recorded videos during their video-EEG monitoring admission and investigated the seizure variability. We extracted all the clinical data from their medical records. We also studied factors potentially associated with seizure variability. RESULTS: Forty nine patients were studied and 220 seizures were reviewed and classified. Mean number of seizures per patient was 4.5. Twenty seven (55%) patients had subjective seizures, 26 (53%) had generalized motor, 14 (29%) had akinetic and five (10%) had focal motor seizures. Twenty eight (57%) patients had only one seizure class, while 19 (39%) patients had two different seizure classes and two (4%) patients had three seizure classes. Among 28 patients with one seizure class, 14 (50%) patients had variable semiologies from one seizure to the other. Hence, 71.5% of the patients showed either inter- or intra-class variability, whereas seizures were stereotypical in 28.5%. No demographic or clinical factors were significantly associated with variability of PNES semiology. CONCLUSION: Neither the stereotypy nor the variability of PNES can or should be used as a marker of the disease and to differentiate PNES from epilepsy. The variability of the episodes of PNES does not hinder an appropriate classification of these seizures.

Ictal kissing: occurrence and etiology.

Ictal kissing is a rare semiological manifestation in patients with epilepsy. We tried to estimate its occurrence and characterize the underlying etiology. We retrospectively reviewed all video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term "kiss". We then searched the electronic database PubMed on September 21, 2016 using the following search terms in the English language: "ictal" OR "seizure" OR "epilepsy" AND "kiss" OR "kissing". Relevant original studies were included. During the study period, 5133 patients were investigated in our epilepsy monitoring unit. One patient (0.02%) had one episode of documented ictal kissing. He had drug-resistant right mesial temporal lobe epilepsy. In total, five studies met the criteria for inclusion in the review. These studies described nine patients with drug-resistant focal epilepsy and ictal kissing behavior. Six out of ten patients with ictal kissing had hippocampal sclerosis. We add to the literature on ictal kissing by providing additional information on its frequency and etiology. The most common underlying etiology for ictal kissing is hippocampal sclerosis. However, this semiological ictal phenomenon is not pathognomonic for any etiology or localization.