Which conversion symptom is commonly misdiagnosed as epilepsy, and how is it distinguished?

• A. PNES are diagnosed by typical epileptiform activity on EEG.
• B. PNES is distinguished by uniform seizure features and clear EEG findings.
• C. PNES shows lack of epileptiform activity on EEG, inconsistent seizure features, and often a psychiatric context; diagnosis requires video-EEG monitoring.
• D. PNES is the same as epilepsy, just misclassified.

Answer: (C)

The key idea is that PNES are conversion-type events that mimic seizures but are not epileptic. They typically lack the electrical signatures of epilepsy on EEG during the spells, show inconsistent or variable semiology from one episode to the next, and often occur in a psychiatric or psychosocial context. Because of this, confirming PNES relies on objective monitoring that captures events while recording brain activity—video-EEG monitoring—so clinicians can verify that there is no epileptiform activity during the spells.

This makes the chosen statement the best: it describes the absence of epileptiform activity on EEG, the inconsistent nature of the spells, and the psychiatric context, with a diagnostic process that uses video-EEG monitoring to distinguish PNES from epilepsy. In contrast, epileptic seizures would show epileptiform activity on EEG, uniform and typical seizure features, and do not require video-EEG to differentiate, and PNES is not the same as epilepsy.