Semiological classification of psychogenic nonepileptic seizures: A systematic review and a new proposal

Purpose: A semiological classification of psychogenic nonepileptic seizures (PNES) may help address proper diagnosis and management and also provide standardization for future studies. The aim of the current paper was to systematically review the literature on the proposed classification systems for the semiology of PNES and to provide a new proposal based on the best available evidence. Methods: I searched the electronic database PubMed on May 16, 2019 for articles that included the following search terms: "psychogenic" AND "semiology" or "classification" and also "nonepileptic" AND "semiology" or "dassification" and also "pseudoseizure" AND "semiology" or "classification" since 1940. I applied the same methodology using the electronic database Scopus, though I limited the search to the title, abstract, and keywords. Results: I could identify 15 classification systems through this search strategy using the electronic database PubMed. Searching the Scopus did not yield any additional relevant papers. Conclusion: I proposed a new semiological classification system for PNES based on this systematic review. This includes three major classes of motor seizures, nonmotor seizures, and mixed semiology. A universally accepted and appropriate semiological classification system for PNES may lead to better standardization of future studies and may also help in better understanding of the pathophysiological basis of this condition. (C) 2019 Elsevier Inc. All rights reserved.