Faculty Bibliography

Studies of patients with psychogenic non-epileptic seizures (NES) typically focus upon the phenomenology and outcome of NES episodes. Little is known, however, about the frequency and nature of other somatic symptoms such as pain, in this population. To assess the frequency, location and severity of symptoms of pain among NES patients, we administered structured interviews to 56 patients, 6 or more months following the diagnosis of psychogenic non-epileptic seizures (NES). Patients were recruited from a tertiary hospital-based epilepsy monitoring unit. Seventy-seven percent of patients suffered from moderate to severe pain, most commonly headache (61%), while neck pain and backache were also common. Twenty-six of 27 patients with persistent NES vs. 17 of 29 patients whose NES resolved experienced moderate to severe pain (P < 0.001). Pain is an under-recognized problem that occurs frequently and with significant severity among NES patients. Pain symptoms are more common among patients with persistent NES than those whose NES resolve

PURPOSE: To attain a comprehensive profile of clinical, psychiatric and psychosocial characteristics of patients with psychogenic nonepileptic seizures (NESs), and to assess the relation of these factors to NES outcome. METHODS: We administered a telephone-based structured questionnaire to 56 patients with NESs (16 male and 40 female patients; mean age, 35 years) at a mean follow-up time of 18 months after making the diagnosis of NES. RESULTS: Mean age of NES onset was 28 years with a mean duration of 8 years. Episodes resolved in 29 (51.8%) cases, decreased in 24 (42.9%), persisted unchanged in two (3.6%), and increased in frequency in one (1.8%). Thirty (53.6%) patients, including 13 (44.8%) of patients whose NESs resolved, were rehospitalized for NESs or for other symptoms. Twenty-nine (51.8%) had significant depressive symptoms, 22 (39.3%) had suicidal ideation, and 11 (19.6%) attempted suicide [including 6 (21%) of the patients whose NESs resolved]. Believing the NES diagnosis was associated with resolution or improvement of NES frequency (p<0.029), whereas anger in response to receiving the diagnosis did not predict a poorer outcome. Patients' perceptions of having good health (p<0.02) and good occupational functioning (p<0.04) were highly correlated with NES resolution. Only patients whose episodes resolved were employed at the time of follow-up. CONCLUSIONS: At a mean of 1.5 years, NES outcome was poor, with resolution in only half the group and with frequent rehospitalizations after NES diagnosis, even among patients whose NES resolved. Depressive symptoms, suicidal ideation, and suicide attempts were common. Believing the NES diagnosis and patient perceptions of having good health and good occupational functioning correlated well with NES resolution

We report two patients with intractable partial seizures who developed generalized nonconvulsive status epilepticus (NCSE) after receiving tiagabine (TGB). Neither had a history of absence seizures or generalized epileptic discharges on prior EEG monitoring. Clinicians need to be aware of a possible association between TGB and NCSE

The aim of the study was to assess whether post-ictal symptoms can help distinguish patients who have epileptic seizures from those with non-epileptic seizures (NES). We reviewed the spontaneous responses to the question 'What symptoms do you have after a seizure?' in 16 patients with epileptic seizures (predominantly focal with secondary generalization or generalized tonic-clonic) and 23 NES patients. Six of the 16 patients (38%) vs. only one of 23 NES patients (4.3%) noted post-ictal headache (P = 0.008). Nine epilepsy patients (56%) vs. three NES patients (13%) reported post-ictal fatigue (P = 0.004). Confusion or other symptoms did not distinguish epilepsy patients from those with NES. All epilepsy patients had at least one post-ictal symptom while 12 NES patients (52%) had none (P = 0.001). Therefore, patients evaluated for epileptic vs. non-epileptic seizures who have post-ictal fatigue or headache, are more likely to have epileptic seizures. Patients with a diagnosis of NES who note post-ictal fatigue or headache should be investigated further

The aim of this study was to assess prognosis among adult patients with nonepileptic seizures (NES) and to determine predictor variables for resolution of NES after diagnosis. Six to 9 months after receiving a video-EEG-documented diagnosis of NES, 43 adults responded by telephone interview to a detailed, structured questionnaire probing history of the episodes, psychiatric factors, socioeconomic variables, relationships, reactions to receiving the diagnosis, and potential history of litigation. At follow-up, only 18.6% were episode-free, 55.8% had improved, 16.3% reported no change, and 9.3% reported greater frequency of episodes. Patients who reported having many friends currently or having good relationships with friends as a child were significantly more likely to be episode-free. Subjects with pending litigation were significantly less likely to experience a reduction in episodes

This review highlights our understanding of episodic phenomena in children and adolescents that resemble epileptic seizures. Although the initial focus is on psychogenically determined nonepileptic seizures (NES; pseudoseizures), other forms of conversion symptoms are also discussed. We subsequently examine the diverse nonpsychogenic, nonepileptic paroxysmal disorders that may be encountered in this age group.