Seizure, Fit or Attack? The Use of Diagnostic Labels by Patients with Epileptic or Non-epileptic Seizures

Abstract

We present an analysis of the use of diagnostic labels such as seizure, attack, fit and blackout by patients who experience seizures. While previous research on patients' preferences for diagnostic terminology has relied on questionnaires, we assess patients' own preferences and their responses to a doctor's use of different labels through the qualitative and quantitative analysis of doctor-patient interactions in a realistic clinical setting. We also examine whether two subgroups of patients -those with epileptic seizures and those with (psychogenic) nonepileptic seizures -show different behaviours in this respect. Our findings suggest firstly that patients make fine lexical distinctions between the various diagnostic labels they use to describe their seizure experiences; secondly, that patients play an active role in the development and application of labels for their medical complaint; and thirdly, that attention to patients' lexical choices and interactive use or avoidance of labels can be relevant for the differential diagnosis of seizures.

The role of companions in outpatient seizure clinic interactions: A pilot study

“…This observation is very much in keeping with those made in previous studies of dyadic interactions between seizure patients and doctors [1][2][27][28][29][30][31][32][33][34]. We found that these differences in the interactional behaviour of patients are closely associated with differences in the interactional contributions made by their companions.…”

Understanding psychogenic nonepileptic seizures—Phenomenology, semiology and the Integrative Cognitive Model

“…Narratives of patients with epilepsy typically normalise seizure experiences whereas patients with PNES often catastrophise [55]. Patients with epilepsy are happy to call their main symptom a seizure whereas those with PNES often avoid labels and prefer pronouns [56]. These observations concur with other data suggesting that many patients with PNES have an avoidant coping style [57,58], and that the attacks themselves are often an anxiety-based phenomenon, albeit not one that is always recognised as such by patients.…”

Consciousness in Non-Epileptic Attack Disorder

“…This observation is in keeping with another study focusing on the use of the medical labels which found that patients with NEAD were more likely than those with epilepsy to resist terms such as "seizure" or "attack" which imply that ictal symptoms are the consequence of an external agent acting on the patients' body [54]. It also fits with the findings of a study in which 48 patients with video-EEG proven epilepsy or NEAD were contacted after a major earthquake: 23% of patients with epilepsy but none with NEAD volunteered that they thought that they were going into a seizure when they first became aware of the earthquake [78].…”