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Table 3 Key-points of practical management (positive and severity diagnoses) according to the scenario

From: The first-line management of psychogenic non-epileptic seizures (PNES) in adults in the emergency: a practical approach

 First suspicious episode (s)Previous similar episodesDiagnosed epilepsy (unknown PNES)Known PNES diagnosisPNES status
History key-points- Details suggestive of PNES?
- Psychic bases?
- Diagnostic score
- Prior semiology (also possible ES?)
- Psychic bases?
- Diagnostic score
- Define the bases of the previous ES diagnosis (clinical? iiEEG? iEEG?)
- Unusual semiology?
- Frequency? AED?
- Recurrence circumstances
- Major psychiatric disorders (especially suicidal risk)?
- Recent social situation of the patient
- Known epilepsy?
Physical examination- Amateur video
- Induction test
- Amateur video
- Induction test
- Amateur video
- Induction test
- Depression diagnostic score if possible- Inhibition test
Early paraclinical investigations- Bedside EEG if possible
- Prolactin level within 10–20 min if possible FBTCS
- Bedside EEG if chances of in-hospital recurrences
- Prolactin level within 10–20 min if possible FBTCS
- Bedside EEG if chances of in-hospital recurrences
- Prolactin dosage within 10–20 min if possible FBTCS
- Not a must
- Prolactin dosage within 10–20 min (maximum of 30 min) if possible FBTCS
- Prolactin dosage (interpretation with caution after the first hour)
- Bedside EEG
Referrals and deferred tests- Routine EEG as outpatient
- Neurology referral
- Systematic routine EEG as outpatient
- Neurology referral
- Neurology referral- Neurology referral- Neurology referral
  1. FBTCS bilateral tonic-clonic seizure, ES epileptic seizure, PNES psychogenic non-epileptic seizure, iEEG ictal electroencephalography, iiEEG interictal electroencephalography, AED antiepileptic drugs