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PSYCHOGENIC (NON-EPILEPTIC) SEIZURES Non-epileptic seizures (NES) are quite common and we encounter them in OPD as well the ER. It is important to make a correct diagnosis of NES in order to start them on appropriate psychiatric treatment and avoid unnecessary anti-epileptic medicines. If we adopt a systematic approach, it would be fairly easy to make a diagnosis of NES. I would classify the diagnostic clues into three headings- history, examination and investigations. Points in history that point towards a diagnosis of non-epileptic seizures 1. Non-epileptic seizures usually occur only in front of others. NES usually do not occur or occur at a lower frequency, when patients are alone. This is because most patients with NES have attention-seeking behaviour.  2. Non-epileptic seizures usually occur at a much higher frequency- in some cases, upto 20-30 or even more number of times per day. Multiple seizures per day are uncommon in patients with true seizures.  3. Immediate r

PSYCHOGENIC MOTOR WEAKNESS Motor weakness is a common symptom presenting in neurology out-patient department or in an emergency room. It is important to determine whether it is of psychogenic or neurological origin. A few clinical signs can help in this matter. 1. Hoover's sign- Place the palm of your hand under the heel of foot on the side with "normal" power and ask the patient to lift the "affected" side. In a person with neurologic (genuine) weakness, you would feel the heel (of the normal foot) pressing against your palm. The affected leg would be weaker. On the other hand, in a person with psychogenic weakness, no pressure would be felt on the palm. 2. Raise the affected arm and let it drop. In a person with neurologic weakness, it falls on the body part if allowed to drop there. On the other hand, in a person with psychogenic weakness, the falling hand avoids any body part in order to avoid getting hurt. Please ensure that while testing, the hand