Communicating diagnostic certainty of psychogenic nonepileptic seizures — a national study of provider documentation

Hamada H. Altalib, Khalid Elzamzamy, Mary Jo Pugh, Javier Ballester Gonzalez, Kei Hoi Cheung, Brenda T. Fenton, Robert D. Kerns, Cynthia A. Brandt, W. Curt LaFrance

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Management of psychogenic nonepileptic seizures (PNES) requires collaboration among and between health care professionals. Although criteria are established for diagnosis of PNES, miscommunication between neurologists, primary care providers, and mental health professionals may occur if the clinical impression is not clearly articulated. We extracted progress notes from the Department of Veterans Affairs (VA) electronic health record (EHR) nationally to study veterans who were evaluated for PNES. Of the 750 patients being worked up for PNES, the majority of patients did not meet criteria for PNES (64.6%). Of those who were thought to suffer from PNES, 147 (19.6%) met International League Against Epilepsy (ILAE) criteria for documented PNES, 14 (1.9%) for clinically established PNES, and 104 (13.9%) for probable or possible PNES. Neurologists tended to use ambiguous language, such as “thought to be” or “suggestive of” to describe their impressions of patients overall, even those with definitive PNES. Ambiguous language may lead to miscommunication across providers and inappropriate health care.

Original languageEnglish (US)
Pages (from-to)4-8
Number of pages5
JournalEpilepsy and Behavior
StatePublished - Nov 1 2016
Externally publishedYes


  • Differential diagnosis
  • Electronic health records
  • Epilepsy
  • Psychogenic nonepileptic seizures

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Behavioral Neuroscience


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