Table 3 Key-points of practical management (positive and severity diagnoses) according to the scenario
| Â | First suspicious episode (s) | Previous similar episodes | Diagnosed epilepsy (unknown PNES) | Known PNES diagnosis | PNES 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 |