Differential diagnosis of generalized epileptic seizures and psychogenic nonepileptic seizures in clinical practice

Differential diagnosis of seizures is not an easy test not only for a general practitioner, but also for a neurologist due to the presence of a wide range of causal factors of an attack. The comparative diagnosis of generalized epileptic seizures and psychogenic nonepileptic seizures (PNEP) has recently become particularly relevant in medical practice, since the latter are often disguised under the guise of true focal hyperactivation of neurons in the cerebral cortex. The purpose of this article is to analyze the modern approach to solving the described problem with the presentation of the author’s table of comparative clinical and symptomatic picture of diseases, and also, as an example, a clinical observation of a seizure of conversion genesis is presented. Psychogenic non-epileptic seizures are behavioral and emotional manifestations of acute internal psychological distress of a person. At the same time, recent scientific studies indicate that PNEP does not have pathognomonic symptoms, as a result of which it is necessary to involve specialists from various fields of medicine: neurologists, epileptologists and psychiatrists. However, it is possible to identify a group of signs with the greatest specificity, such as lateral tongue biting and lack of pupil photoreaction. Other diagnostic methods can also help in verifying the diagnosis, but the only criterion that allows you to distinguish a generalized true seizure is the fixation of epileptic activity during the attack on the EEG. As an example, this article presents a clinical case of a patient with PNEP.