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This work points out the main differences in the semantic expressions used by patients with psychogenic non-epileptic seizures (PNES) and epileptic seizures (ES). In reference to the body as a phenomenological entity, in ES the concept of the body-object prevails while in PNES the body, with all its life attributes, predominates. In description of seizures and in similitudes and metaphors used, ES patients focus on the description of the attack, trying to close the "gap" with a big effort, while patients with PNES concentrate on the context and on the presence of bystanders. Patients with PNES are unable to describe their own attack, since this it is not at the core of their distress, but rather the manifestation of something else, which is hiding the extreme anguish associated with experiences of the past that cannot be revealed (expressed). In the case of ES, instead, the ability to talk and the willingness to elaborate on the emotions become useful tools for facing the disease, an entity perhaps unsurmountable but at least manageable, to the benefit of everyone. In general, we can say that the experience of a disease (real or symbolic) deserves constant attention because it gives us the opportunity not only to probe the depth of the emotional experiences but also the psychic structure of the individual in front of us. A cure would not be a cure without considering such fundamental elements. It would become a sterile exercise of prescribing medications without paying attention to the person, which is the best way of preserving dignity in a state of illness.

Aims The aim of the study was to highlight the fundamental linguistic elements through a simplified scoring table to build a simplified and easier diagnostic model for linguistic evaluation by nonexperts. Methods The study was based on interviews performed in patients recruited at the University of Milano Bicocca, at the Epilepsy Center of the University of Messina, and at the Epilepsy Monitoring Unit of the University of Rochester, who experienced “seizures” and underwent video-electroencephalogram (vEEG) for differential diagnosis. All enrolled subjects underwent a video-recorded interview consisting of a fixed sequence of five questions. Subsequently, a researcher examined the video recordings, blind to the vEEG results, and filled in the simplified linguistic evaluation (SLE) scoring table. The best cutoff score for the diagnosis was determined using a ROC curve and was selected as the value leading to the maximum number of patients correctly classified. Results The study sample consisted of 35 interviews. The receiver operating characteristics (ROC) curve analysis showed that the best cutoff for the diagnosis was 12. The accuracy was 82.9% for this cutoff value. The area under the ROC curve (AUC) was 0.81 (95% confidence interval (CI): 0.66–0.97). Classifying patients using the SLE scoring table as diagnostic tool, with the selected cutoff score, 17 out of 19 patients with psychogenic nonepileptic seizures (PNES) were correctly classified (89.5% sensitivity), while 12 out of 16 patients with epileptic seizures (ES) were correctly classified (75% specificity). Positive and negative predictive values are, respectively, 81% and 85.7%. Conclusions Despite some limitations, the use of the SLE scoring table may reduce costs, and conversation analysis (CA) might help achieving a timely and reliable diagnosis of PNES.

The current study examined the validity of conversational analysis (CA) in Russian patients with seizures, using a scoring table for the Simplified Linguistic Evaluation (SLE). The study sample was composed of 12 adult participants suffering either from epilepsy (ES) or psychogenic nonepileptic seizures (PNES) recruited in the Moscow Research and Clinical Center for Neuropsychiatry. Definitive diagnosis was established only after a habitual event was captured onvEEG. All participants with PNES or ES and at least one mental disorder underwent a 20-minute-long interview recorded on video. The interview then was evaluated by the external blinded physician already experienced in CA. Finally, that physician filled the SLE, consisting of 5 items analyzing the main characteristics of patient narrations. A score of ≥12 suggested a diagnosis of ES, while a score of