Key result
Dysautonomia treatment improves abnormal movements in ~59% of patients misdiagnosed with psychogenic spells.
Why the study?
Patients with autonomic storms presenting with abnormal movements are often misdiagnosed with functional neurological disorders including PNES, leading to delayed or inappropriate treatment.
Does pharmacological management of autonomic dysfunction improve abnormal seizure-like movements in patients initially misdiagnosed with psychogenic non-epileptic spells?
Cohort (n=17)
No
Does pharmacological management of autonomic dysfunction improve abnormal seizure-like movements in patients initially misdiagnosed with psychogenic non-epileptic spells?
Recognizing and treating underlying autonomic dysfunction in patients presenting with non-epileptic seizure-like movements can alleviate these symptoms and reduce hospital readmissions.
Supports autonomic screening in apparent psychogenic spells; leaves open efficacy confirmation in controlled trials.
Background: Patients experiencing autonomic storms related to dysautonomia may present with abnormal movements, including convulsions, tremors, and myoclonus. Due to these nonspecific symptoms, they are often misdiagnosed with functional neurological disorders, including psychogenic non-epileptic spells (PNES), resulting in delayed or inappropriate treatment. Methods: This cohort study included 17 adult patients who presented to St. Elizabeth's Medical Center's emergency department with abnormal seizure-like activity. Inclusion criteria required non-epileptiform movements, confirmed by negative rEEG or cEEG testing, followed by a misdiagnosis of a functional neurological disorder, and referral to Neurology. Demographic and clinical information was collected from the electronic health record to describe the clinical pattern and treatment responses in patients with AMD initially diagnosed with PNES. Results: = 6). All participants showed features of orthostatic hypotension, indicating possible dysautonomia. 14 of 17 patients were started on at least one medication for symptom management, including fludrocortisone, pyridostigmine, midodrine, and propranolol, with 8 of 17 on combination therapy. 10 of 17 patients who underwent pharmacological interventions reported improvement, including a decrease or resolution of abnormal movements, reduction of autonomic dysfunction symptoms, and fewer readmissions. Conclusion: Patients presenting with abnormal seizure-like movements confirmed as non-epileptic after further evaluation should be assessed for autonomic dysfunction. Treatment targeting orthostatic hypotension may help alleviate these abnormal movements.
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Khoo et al. (2026) conducted a cohort in Autonomic movement disorders misdiagnosed as psychogenic non-epileptiform spells (n=17). Pharmacological treatment for dysautonomia (e.g., fludrocortisone, pyridostigmine, midodrine, beta-blockers) vs. None (no control group) was evaluated on Clinical improvement of abnormal movements and reduction in autonomic dysfunction symptoms. Pharmacological treatment for orthostatic hypotension and dysautonomia led to clinical improvement and reduction of abnormal movements in 10 of 17 treated patients originally misdiagnosed with psychogenic non-epileptic spells.
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