What is a differential diagnosis when a patient presents with sudden, non-epileptic movements?

• A. Acute stress reaction
• B. Migraine with aura
• C. Psychogenic non-epileptic seizures (PNES)
• D. Tics from Tourette syndrome

Answer: (C)

Episodes that look like seizures but lack epileptic brain activity point to a psychogenic non-epileptic seizure. These events are real experiences for the patient and are driven by psychological factors rather than abnormal electrical discharges in the brain. Recognizing PNES as the presentation helps differentiate them from true epilepsy and guides management away from unnecessary antiseizure medications toward psychological assessment and treatment, such as psychotherapy, stress management, and supportive care. Features often described include sudden, seizure-like movements without consistent epileptic patterns on EEG and a course that may be closely tied to emotional or stress-related factors, though the definitive distinction is usually made with video EEG monitoring showing no ictal epileptiform activity.

Migraine with aura would typically present with sensory or visual disturbances followed by headache, not focal motor episodes that resemble seizures. An acute stress reaction can cause a range of symptoms but is not defined by recurrent seizure-like events with no EEG correlate. Tics from Tourette syndrome are repetitive motor movements or sounds that are usually stereotyped and can be suppressed for periods; they do not typically present as sudden, unprovoked events that mimic seizures.