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Nonepileptic Seizures: Issues in Differential Diagnosis and Treatment

Published online by Cambridge University Press:  07 November 2014

Abstract

Nonepileptic seizures (NES) are clinical events that can resemble almost any seizure phenotype, but are behavioral and emotional manifestations of psychological distress, conflict, or trauma. Intractable NES is a disabling disorder that drastically affects patients' emotional well-being. Differential diagnosis, assessment, and treatment of NES is complex, with differentials scattered across an array of neurological and psychiatric disorders. This paper provides an overview of issues related to the diagnosis and treatment of NES. It highlights characteristics and risk factors of the disorder, issues in differential diagnosis, and treatment considerations.

Type
Feature Articles
Copyright
Copyright © Cambridge University Press 1997

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References

1.Gates, JR, Mercer, K. Nonepileptic events. Semin Neurol. 1995;15(suppl 2):167174.Google Scholar
2.Barsky, AJ, Wool, C, Barnett, MC, Cleary, PD. Histories of childhood trauma in adult hypochondriacal patients. Aw J Psychiatry. 1994;151(suppl 3):397401.Google Scholar
3.Alper, K, Devinsky, O, Perrine, K, Vazquez, B, Luciano, D. Nonepileptic seizures and childhood sexual and physical abuse. Neurology. 1993;43:19501953.Google Scholar
4.Charcot, JM. Charcot and the idea of hysteria in the male: Gender, mental science, and medical diagnosis in late nineteenth-century France. Medical History 1990; 34, 363411, 376. 1990.Google Scholar
5.Bortz, JJ, Stonnington, C. Clinical and neuropsychological features of male patients with nonepileptic seizures. Epilepsia. 1995;36(suppl 4):136. Abstract.Google Scholar
6.Bowman, ES, Markland, OM. Psychodynamics and psychiatric diagnoses of pseudoseizure subjects. Am J Psychiatry. 1996;153(suppl 1):5763.Google Scholar
7.Sackellares, JC, Giordani, B, Berent, S, et al.Patients with pseudoseizures: intellectual and cognitive performance. Neurology. 1985;35:116119.Google Scholar
8.Wilkus, RH, Dodrill, CB, Thompson, PM. Intensive EEG, monitoring and psychological studies of patients with pseudo-epileptic seizures. Epilepsia. 1984;25:100107.CrossRefGoogle Scholar
9.Hermann, BP. Neuropsychological assessment in the diagnosis of non-epileptic seizures. In: Rowan, AJ, Gates, JR, eds. Nonepileptic Seizures. Stoneham, Mass: Butterworth-Heinemann; 1993:221232.Google Scholar
10.Wilkus, RJ, Dodrill, CB. Factors affecting the outcome of MMPI and neuropsychological assessments of psychogenic and epileptic seizure patients. Epilepsia. 1989;30:339347.Google Scholar
11.Heinrichs, TF, Tucker, DM, Farha, J, Novelly, RA. MMPI indices in the identification of patients evidencing pseudoseizures. Epilepsia. 1988;21:184187.Google Scholar
12.Mason, SL, Mercer, K, Risse, GL, Gates, JR. Epilepsia. 1996;37(suppl 5):18. Abstract.Google Scholar
13.Connell, BE, Wilner, AM. MMPI-2 distinguishes intractable epilepsy from pseudoseizures: a replication. Epilepsia. 1996;37(suppl 5):19. Abstract.Google Scholar
14.Derry, PA, McLachlan, RS. The MMPI-2 as an adjunct to the diagnosis of pseudoseizures. Seizure. 1996;5(suppl 1):3540.Google Scholar
15.Dellis, DC, Kramer, JH, Kaplan, E, Ober, BA. California Verbal Learning Test. New York, NY: Psychological Corporation; 1987.Google Scholar
16.Bortz, JJ, Prigatano, GP. Blum, D, Fisher, RS. Differential response characteristics in nonepileptic and epileptic seizure patients on a test of verbal learning and memory. Neurology. 1995;45:20292035.Google Scholar
17.Lesser, RP. Psychogenic seizures. Neurology. 1996;46:14991507.Google Scholar
18.Lelliot, PT, Fenwick, P. Cerebral pathology in pseudoseizures. Acta Neurol Scand. 1991;83:129132.Google Scholar
19.Ramsay, RE, Cohen, A, Brown, MC. Coexisting epilepsy and non-epileptic seizures. In: Rowan, AJ, Gates, JR, eds. Nonepileptic Seizures. Stoneham, Mass: Butterworth-Heinemann; 1993:4754.Google Scholar
20.Boon, PA, Williamson, PD. The diagnosis of pseudoseizures. Clin Neurol Neurosurg. 1993;95:18.CrossRefGoogle ScholarPubMed
21.Saygi, S, Katz, A, Marks, DA, Spencer, SS. Frontal lobe partial seizures and psychogenic seizures: comparison of clinical and ictal characteristics. Neurology. 1992;42:12741277.Google Scholar
22.Evans, RW. Neurologic aspects of hyperventilation syndrome. Semin Neurol. 1995;15(suppl 2):115125.Google Scholar
23.Gates, JR, Erdahl, P. Classification of non-epileptic events. In: Rowan, AJ, Gates, JR, eds. Non-Epileptic Seizures. Boston, Mass: Bulterworth-Heinemann; 1993:2130.Google Scholar
24.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
25.Toone, BK. Somatization: physical symptoms and psychological illness. In: Bass, C, ed. Disorders of Hysterical Conversion. London, England: Blackwell; 1990:207234.Google Scholar
26.Devinsky, O, Fisher, RS. Ethical use of placebos and provocative testing in diagnosis of epilepsy. Neurology. 1996;47:866870.Google Scholar
27.Leahey, T, Harris, RJ. Fundamentals of conditioning. In Leahey, T and Harris, RJ eds. Human Learning. Englewood Cliffs: Prentice Hall; 1985:2142.Google Scholar
28.Franks, CM, Barbrack, CR. Behavior therapy with adults: an integrative perspective for the nineties. In: Hersen, M, Kazdin, AE, Bellack, AS, eds. The Clinical Psychology Handbook. 2nd ed. Elmsford, NY: Pergamon Press; 1991:551556.Google Scholar
29.Haynes, SN. Behavioral assessment. In: Hersen, M, Kazdin, AE, Bellack, AS, eds. The Clinical Psychology Handbook. 2nd ed. Elmsford, NY: Pergamon Press; 1991:430464.Google Scholar
30.Beck, A. Depression: Clinical, Experimental, and Theoretical Aspects. New York, NY: Harper & Row; 1967:Google Scholar
31.Beck, AT. Cognitive Therapy and the Emotional Disorders. New York, NY: International Universities Press; 1976.Google Scholar
32.Beck, AT, Rush, AJ, Shaw, BF, Emery, G. Cognitive Therapy of Depression: A Treatment Manual. New York, NY: Guilford Press; 1979.Google Scholar
33.Blatt, SJ, Lerner, H. Psychodynamic perspectives on personality theory. In: Hersen, M, Kazdin, AE, Bellack, AS, eds. The Clinical Psychology Handbook. 2nd ed. New York, NY: Pergamon Press, 1991.147169.Google Scholar
34.Mann, J. Time-limited Psychotherapy. Cambridge, Mass: Harvard University Press; 1973:18.Google Scholar
35.Meierkord, H, Will, B, Fish, D, Shorvon, S. The clinical features and prognosis of pseudoseizures diagnosed using video-EEG telemetry. Neurology. 1991;41:16431647.CrossRefGoogle ScholarPubMed
36.Lempert, Schmidt D. Natural history and outcome of psychogenic seizures: a clinical study in 50 patients. J Neurol. 1990;237:3538.Google Scholar