To assess for adherence in the best practices for evaluation of Psychogenic non-epileptic seizures (PNES), as pertains to EEG testing.

Hospital-based Video EEG is the gold standard diagnosis for PNES while ambulatory EEG without video was found to be less well suited. We reviewed data at level IV epilepsy center to assess adherence to best practice parameters in patients found to have PNES.

Retrospective case series at a level IV epilepsy center. We analyzed data for patients 18 years and above confirmed to have PNES by EEG including video (VEEG), routine (REEG) and ambulatory (AEEG) from 01/01/2010 to 6/1/2017 with at least one captured event. EEG database was searched for “PNES” meeting the above criteria. We reviewed the order in which tests were obtained, duration and findings of the EEG.

86.70 % of patients had VEEG as the initial test, with 82.5% having 2+ stereotypical events over an average of 2.38 days of EEG. A duration of fewer than 2.0 days tended to be associated with few (1) or no events captured and likely retesting. The presence of epileptiform versus non-epileptiform abnormalities on EEG were associated with 3.50 days versus 2.38 days of EEG. REEG versus AEEG as an initial test in 6.96% and 6.63% respectively.

EEG re-testing was seen in 22.78% of the entire population study. Repeat EEG testing was done in 17 (11.68%), 10 (90.91%) and 11 (100.00%) patients who underwent VEEG, REEG and AEEG respectively.  Even after 70% of patients with AEEG had 2 or more events on the initial recording, retesting was required in all.  

VEEG use as the initial test is consistent with best practices, however, AEEG use needs to be limited given prior reports and re-testing seen in this cohort. Two or more days of EEG are associated with a higher yield.