Differentiating and Treating Seizures vs Psychogenic Non-Epileptic Seizures (PNES)

Key Clinical Differentiating Features

Epileptic seizures typically present with symmetrical, synchronous bilateral movements, while PNES often show asynchronous, side-to-side thrashing movements 1
Eyes are typically open during unconsciousness in generalized epileptic seizures 1
Eyes are often closed in PNES 1
Epileptic seizures have a mean duration of unconsciousness of 74-90 seconds, while PNES/syncope typically lasts less than 30 seconds 1
Lateral tongue biting is highly specific for epileptic seizures 1
Chewing, smacking, and blinking suggest epileptic seizures 1

Neuron-specific enolase, prolactin, and creatine kinase are not reliable for validating the diagnosis and should not be relied upon alone for differentiation 1

Antiepileptic drugs are the primary treatment for epileptic seizures, with status epilepticus requiring benzodiazepines followed by phenytoin or fosphenytoin, and EEG testing should be performed when indicated to guide management 2