Tongue biting is usually lateral in real seizures, but medial in PNES

Video-EEG monitoring is the “gold standard’’ for diagnosis of PNES. This is in contrast to other psychogenic symptoms, which are almost always a diagnosis of exclusion.

PNES should be suspected in all patients with frequent seizures despite taking medications. The combined electroclinical analysis of the clinical semiology being clearly incompatible with epileptic seizures and the ictal EEG being normal allow a definitive diagnosis in the vast majority of cases. Limitations of video-EEG monitoring include the fact that ictal EEG may be negative in some partial seizures or uninterpretable if movements generate excessive artifact.

Semiology of PNES include persistent eye closure at the onset of the attack, gradual onset; side-to-side head movements; pelvic thrusting; opisthotonic posturing; stuttering; weeping; pseudosleep; discontinuous (stop and go), irregular, or asynchronous (out of phase) activity; and gradual onset or termination.

Any seizure with eyes closed at the onset of the attack should raise suspicion for a psychogenic seizure. PNES are identified by the typical eye closure from the beginning and the long duration of the event, typically over 5 minutes, which are both very rare in epileptic seizures or syncope. Although closed eyes are typical for PNES, observing open eyes is not a reliable indicator for epileptic seizures. In fact, an upward gaze is often seen in patients having a syncopal episode.

Reflex seizure is a weird type of seizure where the patient will consistently have seizure every time he is exposed to a stimulus (the seizure becomes, in a way, like a reflex).

Flashing lights are the most common triggers, other triggers include music, reading, orgasm, certain points during the menstrual cycles, touching or moving a particular part of the body, ... etc

This is a reflex seizure induced by nothing other than changing the baby's diapers

You can see the change in the baby's facial expressions, a myoclonus of the right arm (0:15) and the tonic seizure in its lower limbs afterwards.

The absence of all three signs of fever, neck stiffness and altered mental state virtually eliminates the diagnosis of meningitis in immunocompetent individuals.

Here's smthn weird:

The trigeminal nerve:
The cell bodies of the sensory fibres are located in the trigeminal ganglion. From the trigeminal ganglion, the main fibers (those responsible for touch, proprioception, and vibration) pass to the pons. but the pain and temperature pathways descend to the spinal cord, to around C2, where they make up the "spinal trigeminal nucleus." Then they ascend back into the thalamus.

باختصار: الألياف العصبية المسؤولة عن إحساس الألم والحرارة بالوجه، بدل ما تروح مباشرةً لجذع الدماغ، رح تنزل للحبل الشوكي (لحد تقريبًا C2) وراها ترجع تصعد للدماغ.

That's why ipsilateral facial numbness may occur with cervical cord lesions.

That's also why there's smthn called "trigeminal tractotomy" where a surgeon would damage the trigeminal spinal tract (and nucleus), thus causing facial numbness.

This operation is used in refractory trigeminal neuralgia (including refractory postherpetic pain).

Basically the cornea moves upward when the patient tries to close his eyes. It's a normal phenomenon and is seen in syncope, and in LMN facial palsy (since the patient cannot close his eyes, he reflexively moves the cornea upward to protect it) among others. It's valuable for determining whether the patient has psychogenic or real coma; in psychogenic coma, the patient still retains Bell's phenomenon. It's not very sensitive but can confirm the diagnosis.

Oncolytic viruses (OVs)