Are we overusing the diagnosis of psychogenic non-epileptic events?

In order to determine how often results of video/EEG (V-EEG) studies may ch ange the clinical diagnosis of paroxysmal events, we prospectively studied 100 consecutive patients (75 females, 25 males) admitted for diagnosis of r ecurrent paroxysmal spells. The presumed diagnosis of the referring physici an was obtained. Episodes were classified as epileptic seizures (ES), psych ogenic non-epileptic events (PNEE), or physiologic non-epileptic events (Ph ysNEE). Eighty-seven patients had diagnostic events. A final diagnosis of E S was made in 21 patients, PNEE in 39, PNEE + ES in 20, and PhysNEE in seve n. All PhysNEE were unsuspected. ES were misdiagnosed as PNEE more frequent ly than the reverse (57% vs. 12%, P < 0.001). Among the 64 patients with re corded events who had been suspected of having PNEE, 14 (21.9%) were misdia gnosed: two had PhysNEE and 12 (18.75%) had ES. Among the 23 patients with recorded events who were thought to have ES, 12(39.1%) were misdiagnosed: s even had PNEE, five PhysNEE. V-EEG changed the clinical diagnosis in 29.8% of the patients with recorded events. Our data suggests that clinicians hav e become more aware of PNEE since the advent of V-EEG and have little probl em recognizing them. However, they may be more prone to make a false-positi ve diagnosis of PNEE in ES with some atypical features. At this point, effo rts should be channeled to better training in the proper recognition of ES that mimic PNEE.