“Convulsive” Nonepileptic Seizures Have a Characteristic Pattern of Rhythmic Artifact Distinguishing Them from Convulsive Epileptic Seizures

Summary:  Purpose:  Approximately 30% of patients admitted for video‐EEG monitoring have psychogenic nonepileptic seizures (PNES). Differentiation of “convulsive” PNES from convulsive seizures can be difficult. The EEG often displays rhythmic movement artifact that may resemble seizure activity and confound the interpretation. We sought to determine whether time–frequency mapping of the rhythmic EEG artifact during “convulsive” PNES reveals a pattern that differs from that of epileptic seizures. Methods:  EEGs from 15 consecutive patients with “convulsive” PNESs were studied with time–frequency mapping by using NEUROSCAN and compared with 15 patients with convulsive epileptic seizures. Fast Fourier transforms (FFTs) were performed to determine the dominant frequency for 1‐ to 2‐s windows every 2 s through the seizures. Results:  The dominant frequency remained stable within a narrow range for the duration of the PNES, whereas in the epileptic seizures, it evolved through a wide range. The coefficient of variation of the frequency during the seizures was considerably less for patients without epilepsy (median, 15.0%; range, 7.2–23.7% vs. median, 58.0%; range, 34.8–92.1%; p < 0.001). The median frequency did not differ significantly between groups (4.2 vs. 4.6 Hz; p = 0.290). Conclusions:  “Convulsive” PNES display a characteristic pattern on time–frequency mapping of the EEG artifact, with a stable, nonevolving frequency that is different from the evolving pattern seen during an epileptic seizure.