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Syncope pp 135-147 | Cite as

Psychogenic Pseudosyncope and Pseudoseizure: Approach and Treatment

  • Raffaello FurlanEmail author
  • Alessandra Alciati
Chapter
  • 15 Downloads

Abstract

Psychogenic pseudosyncope (PPS) is the appearance of apparent transient loss of consciousness (TLOC) in which movements are absent, resembling syncope but without true loss of consciousness. Psychogenic non-epileptic seizure (PNES) involves apparent TLOC and pronounced movements of limbs, head, and trunk, resembling epilepsy. PPS and PNES differ in their pathophysiology from true transient loss of consciousness (TLOC), as in PPS the hemodynamic and electroencephalographic changes characterizing syncope are absent and in PNES the epileptiform brain activity during the attack is absent.

A detailed history is of paramount importance for the diagnosis. Clinical clues that should raise the suspicion for psychogenic spells are similar for PPS and PNES and include the high frequency of attacks, prolonged duration of the loss of consciousness, eye closure during the episode, unusual triggers, and no recognizable prodromes. The presence of an established diagnosis of syncope or epilepsy should not deter from the concomitant diagnosis of PPS.

The gold standard for diagnosis of PPS is documenting an attack with video or with tilt testing during which hemodynamic and electroencephalographic parameters are normal. The gold standard for PNES is documenting an attack with video-EEG monitoring showing no epileptiform brain activity during an attack.

For both PPS and PNES, treatment is based on the clear and empathetic communication of the diagnosis which can often be followed by an immediate reduction of attack frequency and emergency service use. Psychological interventions may be beneficial in patients with PPS/PNES and among these, Cognitive Behavioral Therapy holds the most reliable evidence of efficacy.

Keywords

Syncope Pseudosyncope Pseudoseizure TLOC Conversion disorders Cognitive behavioral therapy Psychotherapy Hypnosis Psychogenic EEG Nonepileptic Tilt-testing 

Notes

Acknowledgements

We would like to thank A.C. for providing us with the video recordings of the pseudosyncope attacks that were obtained by her friends and relatives.

We have also to acknowledge the work done by Dr. Roberto Menè, Dr. Dana Shiffer, and the Humanitas University IT Director Dr. Antonino Marsala and the IT staff Dr. Federico Sabolla in building up the final video-audio recording. We are thankful to Sachin Paranjape for having edited and revised the manuscript.

Conflict of Interest/Disclosure

None.

Supplementary material

Video 11.1

Examples of pseudosyncope attacks in an otherwise healthy young woman (MP4 253739 kb)

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Internal MedicineHumanitas Clinical and Research Center-IRCCSMilanItaly
  2. 2.Department of Biomedical SciencesHumanitas UniversityMilanItaly
  3. 3.Department of Clinical NeurosciencesHermanas Hospitalarias, Villa S. Benedetto Menni HospitalAlbese con CassanoItaly

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