Pseudoseizures

Abstract

A prospective study of pseudoseizures using prolonged video-electroencephalographic (EEG) recording was carried out in 60 patients. Of 33 patients with episodes of uncertain mechanism, a diagnosis based on recorded episodes was made in 18 (55%). Twelve (36%) had pseudoseizures; 6 (18%) had epileptic seizures. Ten additional patients had epileptiform EEGs compatible with epilepsy. Of 27 patients with presumably uncontrolled epileptic seizures, 4 (15%) had recorded pseudoseizures. Prediction of the nature of the episode by the admitting neurologist was accurate in 67% of cases. Determination from observations of unit personnel and neurologists was correct in less than 80% of episodes. These data suggest that pseudoseizures occur frequently in patients being evaluated for epilepsy or suspected epilepsy. The clinical differentiation between epileptic seizures and pseudoseizures is often inaccurate. This differentiation is facilitated by prolonged video-EEG recording.

Quality of Life in Psychogenic Nonepileptic Seizures

“…One patient with presumptive diagnosis of frontal lobe complex partial seizures was included in the category of possible seizures because of lack of any EEG changes during the stereotypical events. The clinical characteristics of the events were suggestive of frontal lobe complex partial seizures, which are sometimes difficult to distinguish from the PNESs (16,18).…”

“…Clinicians had no access to the patient's responses to the questionnaires when making the final diagnosis. Although the clinical features and neuropsychological profile of the patient may by suggestive of the diagnosis of PNESs, the final diagnosis can be confirmed only by simultaneous video recording of the clinical behavior and with EEG (15,16,18). Therefore the diagnosis of PNESs versus ESs in all patients included in this study is based on the results of the prolonged video-EEG monitoring (PVEM), the clinical characteristics of the events recorded, and other supporting evidence (e.g., neuropsychological testing/MMPI).…”

“…They are difficult to diagnose solely on the basis of clinical criteria and a normal interictal EEG (15)(16)(17)(18). Because clinically PNESs are very similar to ESs, it is reasonable to assume that the effects of PNESs on HRQOL are similar to the effects ESs have on patients with pharmacoresistant epilepsy.…”

“…The majority of PNES research has focused on the clinical characteristics of PNESs or on predicting the diagnosis based on MMPI and clinical history data (16,(27)(28)(29). Other studies evaluated the association between PNESs and psychological or sexual trauma or other psychiatric comorbities (30,31), outcome after the diagnosis of PNESs (13,(24)(25)(26), or the incidence of PNESs (20,21).…”

Psychogenic non-epileptic seizures and psychoanalytical treatment: results

“…In a study 31 conducted for an average of 12 weeks and which included 16 patients, the authors found cessation of seizures in 9 (56.2%) patients. King et al 32 treated 14 patients and reported effectiveness in the cessation and improvement of seizures at 79%. The educational approach has also been indicated 33 as a form of support and assistance for patients, aimed at accepting the psychological nature of their symptoms and the need for psychological monitoring.…”