What is the preferred method for diagnosing psychogenic nonepileptic seizures?

The preferred method for diagnosing psychogenic nonepileptic seizures (PNES) is through video-electroencephalography (video-EEG). This method allows healthcare providers to simultaneously record the patient's brain activity and video capture of the seizures.

During an episode, video-EEG monitoring can reveal whether there is an epileptiform discharge in the brain during the seizure, which would indicate a true epileptic seizure. In contrast, PNES will not show these abnormal electrical discharges but may exhibit behavioral patterns indicative of psychological origins. The ability to observe the seizure in conjunction with the EEG helps differentiate between psychogenic events and epileptic seizures, significantly aiding in accurate diagnosis and appropriate management.

Other imaging techniques, such as CT scans and MRIs, provide structural images of the brain but do not capture the electrical activity during a seizure and thus are not suitable for diagnosing PNES. Electromyography (EMG), while useful for assessing muscle activity, is not relevant for distinguishing seizure types at the brain level. Hence, video-EEG stands out as the most effective diagnostic tool for identifying psychogenic nonepileptic seizures.