Nonepileptic psychogenic seizures (NESs) are episodes of clinical seizurelike activity that do not result from abnormal electrochemical activity in the brain. NESs are potentially life-threatening, owing to iatrogenic morbidity from futile attempts to control the seizurelike activity. About 20% or more of patients with NESs also have epileptic seizures.22,23

Patients with NESs may have a history of psychiatric disease, an unusual medical history, or an atypical response to AEDs. Clinically, they may present with unresponsiveness and minor movements, although sometimes they may present with generalized convulsive movements. Features that sometimes identify NESs include:

  • side-to-side head movements
  • asynchronous motor movements
  • pelvic thrusting
  • forced eye closure and guarding the face when presumed to be unresponsive
  • alerting to stimuli during convulsive movements

Diagnosis and treatment of this condition are usually beyond the ED setting. Its presentation often results in hospital admission.24

Adapted from: Kolb SJ and Litt B. Management of epilepsy and comorbid disorders in the emergency room and intensive care unit. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;515–535. With permission from Elsevier (

Authored By: 
Steven J. Kolb Md PhD
Brian Litt MD
Reviewed By: 
Steven C. Schachter MD
Saturday, May 1, 2004