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Nonepileptic seizures

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Opinion statement

The primary goal of treatment in nonepileptic seizures (NES) is to improve the patient’s quality of life by terminating seizure production or reducing seizure frequency. Initial treatment consists of explaining the diagnosis and its psychological nature to patients without judging them or giving the NES excessive attention. Next, help patients identify stresses and refer them for mental health treatment. Neurologists should continue to see patients intermittently to wean anticonvulsants, and encourage compliance with mental health care. Psychiatric treatment of NES has the following three aims: 1) Help patients identify and eliminate contributing stresses. 2) Teach better coping mechanisms and increased expression of suppressed feelings that are being communicated somatically. 3) Diagnose and treat comorbid psychiatric conditions such as depression, anxiety, dissociation, or post-traumatic symptoms. The mainstay of psychiatric treatment for NES is some kind of individual or family psychotherapy or hypnosis. Selective serotonin reuptake inhibitor antidepressant medications (first-line drugs) or tricyclic antidepressants (second-line drugs) may be needed to treat comorbid depression, panic, or post-traumatic stress disorder (PTSD), but medications should nearly always be combined with psychotherapeutic approaches. Benzodiazepines should be used only with psychotherapy to teach better coping. Families or caregivers may need to learn behavior modification to minimize covert environmental rewards for NES. With proper diagnosis and treatment, about 45% of patients will become seizure-free, and another one third of patients will show reduced seizure frequency.

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References

  1. Diagnostic and Statistical Manual of Mental Disorders, edn 3. Washington, DC: American Psychiatric Association; 1980.

  2. Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.

  3. World Health Organization: International Statistical Classification of Diseases and Related Health Problems, edn 10. Geneva: World Health Organization; 1992:F44.

    Google Scholar 

  4. Krumholz A: Nonepileptic seizures: diagnosis and management. Neurology 1999, 53(suppl 2):S76-S83. Excellent general overview of NES with history, epidemiology, prognosis, and helpful tables for diagnosis and general management strategies.

    PubMed  CAS  Google Scholar 

  5. Veith I: Hysteria: The History of a Disease. Chicago: University of Chicago Press; 1965.

    Google Scholar 

  6. Janet P: The Major Symptoms of Hysteria. New York: MacMillan; 1907.

    Google Scholar 

  7. Rosenbaum M: Psychogenic seizures: why women? Psychosomatics 2000, 41:147–149.

    Article  PubMed  CAS  Google Scholar 

  8. Bowman ES, Markand ON: A study of the contribution of life events to pseudoseizure occurrence in adults. Bulletin of the Menninger Clinic 1999, 63:70–88.

    PubMed  CAS  Google Scholar 

  9. Gates JR: Epidemiology and classification of non-epileptic events. In Non-Epileptic Seizures, edn 2. Edited by JR Gates, AJ Rowan. Boston: Butterworth-Heinemann; 2000:3–14.

    Google Scholar 

  10. Kuyk JA, Neinardi H, Spinhoven P, van Dyck R: The diagnosis of psychogenic nonepileptic seizures: a review. Seizure 1997, 6:243–253.

    Article  PubMed  CAS  Google Scholar 

  11. Bowman ES: Etiology and clinical course of pseudoseizures: relationship to trauma, depression and dissociation. Psychosomatics 1993, 34:333–342.

    PubMed  CAS  Google Scholar 

  12. Rowan AJ: Diagnosis of non-epileptic seizures. In Non-Epileptic Seizures, edn 2. Edited by JR Gates, AJ Rowan. Boston: Butterworth-Heinemann; 2000:15–30.

    Google Scholar 

  13. Devinsky O, Paraiso JO: Unusual epileptic events and non-epileptic seizures: differential diagnosis and coexistence. In individual psychodynamic therapy. In Non-Epileptic Seizures, edn 2. Edited by JR Gates, AJ Rowan. Boston: Butterworth-Heinemann; 2000:31–50.

    Google Scholar 

  14. Leis AA, Ross MA, Summers AK: Psychogenic seizures: ictal characteristics and diagnostic pitfalls. Neurology 1992, 42:95–99.

    PubMed  CAS  Google Scholar 

  15. Pritchard PB: The role of prolactin in the diagnosis of non-epileptic seizures. In Non-Epileptic Seizures, 1st Edition. Edited by AJ Rowan, JR Gates. Boston: Butterworth-Heinemann; 1993:93–100.

    Google Scholar 

  16. Wyler AR, Richey ET, Hermann BP: Comparison of scalp to subdural recordings for localizing epileptogenic foci. J Epilepsy 1989, 2:91–96.

    Article  Google Scholar 

  17. Bautista RED, Spencer DD, Spencer SS: EEG findings in frontal lobe epilepsies. Neurology 1998, 50:1765–1771.

    PubMed  CAS  Google Scholar 

  18. Saygi S, Katz A, Marks DA, Spencer SS: Frontal lobe partial seizures and psychological seizures: comparison of clinical and ictal characteristics. Neurology 1992, 42:1274–1277.

    PubMed  CAS  Google Scholar 

  19. Ramani V: Treatment of the adult patient with non-epileptic seizures. In Non-Epileptic Seizures, edn 2. Edited by JR Gates, AJ Rowan. Boston: Butterworth-Heinemann; 2000:311–316. A brief overview of the treatment recommendations of five NES experts.

    Google Scholar 

  20. Aboukasm A, Mahr G, Gahry BR, et al.: Retrospective analysis of the effects of psychotherapeutic interventions on outcomes of psychogenic nonepileptic seizures. Epilepsia 1998, 39:470–473.

    Article  PubMed  CAS  Google Scholar 

  21. Wyllie E, Friedman D, Rothner AD, et al.: Psychogenic seizures in children and adolescents: outcome after diagnosis by ictal video and electroencephalographic recording. Pediatrics 1990, 85:480–484.

    PubMed  CAS  Google Scholar 

  22. Shen W, Bowman ES, Markand ON: Presenting the diagnosis of pseudoseizure. Neurology 1990, 40:756–759.

    PubMed  CAS  Google Scholar 

  23. Griffith JL, Polles A, Griffith ME: Pseudoseizures, families, and unspeakable dilemmas. Psychosomatics 1998, 39:144–153.

    PubMed  CAS  Google Scholar 

  24. Bowman ES: Nonepileptic seizures: psychiatric framework, treatment, and outcome. Neurology 1999, 53(suppl2):S84-S88. Practical guide for neurologists in explaining and initially managing NES. Includes overview of psychopathology and outlines treatments and prognosis.

    PubMed  CAS  Google Scholar 

  25. Snyder SL, Rosenbaum DH, Rowan AJ, Strain JJ: SCID diagnosis of panic disorder in psychogenic seizure patients. J Neuropsychiatry Clin Neurosci 1994, 6:261–266.

    PubMed  CAS  Google Scholar 

  26. Alper K, Devinsky O, Perrine K, et al.: Nonepileptic seizures and childhood sexual and physical abuse. Neurology 1993, 43:1950–1953.

    PubMed  CAS  Google Scholar 

  27. Arnold LM, Privitera MD: Psychopathology and trauma in epileptic and psychogenic seizure patients. Psychosomatics 1996, 37:438–443.

    PubMed  CAS  Google Scholar 

  28. Ramani V: Review of psychiatric treatment strategies in non-epileptic seizures. In Non-Epileptic Seizures, edn 1. Edited by AJ Rowan, JR Gates. Boston: Butterworth-Heinemann; 1993:259–267.

    Google Scholar 

  29. Bush E, Barry J, Spiegel D: The successful treatment of pseudoseizures with hypnosis. Epilepsia 1992, 33:135.

    Article  Google Scholar 

  30. Heminghyt E, Areng S, Slinning R: An eclectic approach to the treatment of pseudo-epileptic seizures. In Pseudo-Epileptic Seizures. Edited by Gram L, Johannessen SJ, Osterman PO, Sillanpää M. United Kingdom: Wrightson Biomedical Publishing; 1993:13–145.

    Google Scholar 

  31. McKee MG, Kiffer JF: Biofeedback for pseudoseizures. In Pseudoepilepsy. Edited by M Gross. Lexington: DC Heath; 1983:237–247.

    Google Scholar 

  32. Bowman ES: Psychopathology and outcome in pseudoseizures. In Psychiatric Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment. Edited by AB Ettinger, A Kanner. Hagerstown: Lippincott, Williams & Wilkins; 2000.

    Google Scholar 

  33. Medical Economics Company: Physicians Desk Reference, edn 53. Montvale: Medical Economics Company; 1999.

    Google Scholar 

  34. Nemeroff CB, DeVane CL, Pollock BG: Newer antidepressants and the cytochrome P450 system. Am J Psychiatry 1996, 153:311–320.

    PubMed  CAS  Google Scholar 

  35. Sproule BA, Naranjo CA, Bremner KE, Hassan PC. Selective serotonin reuptake inhibitors and CNS drug interactions. Clinical Pharmacokinetics 1997, 33:454–470. Comprehensive drug-by-drug examination of interactions of SSRI antidepressants and CNS drugs.

    PubMed  CAS  Google Scholar 

  36. Bowman ES, Markand ON: Psychodynamics and psychiatric diagnoses of pseudoseizure patients. Am J Psychiatry 1996, 153:57–63.

    PubMed  CAS  Google Scholar 

  37. Schatzberg AF: Course of depression in adults: treatment options. Psychiatric Ann 1996, 26:336–341.

    Google Scholar 

  38. Ereshefsky L, Alfaro CL, Lam YWF: Treating depression: potential drug interactions. Psychiatric Ann 1997, 27:244–258. The most comprehensive recent review of antidepressant drug interactions. Includes many valuable tables of interactions.

    Google Scholar 

  39. Alldredge BK: Seizure risk associated with psychotropic drugs: clinical and pharmacokinetic considerations. Neurology 1999, 53(suppl 2):S68-S75.

    PubMed  CAS  Google Scholar 

  40. Mohan KK, Markand ON, Salanova V: Diagnostic utility of video EEG monitoring in paroxysmal events. Acta Neurologica Scandinavica 1996, 94:320–325.

    Article  PubMed  CAS  Google Scholar 

  41. Slater JD, Brown MC, Jacobs W, Ramsay RE: Induction of pseudoseizures with intravenous saline placebo. Epilepsia 1995, 36:580–585.

    Article  PubMed  CAS  Google Scholar 

  42. Krahn LE, Rummans TA, Sharbrough FW, et al.: Pseudoseizures after epilepsy surgery. Psychosomatics 1995, 36:487–493.

    PubMed  CAS  Google Scholar 

  43. Walczak TS, Papacostas S, Williams DT, et al.: Outcome after diagnosis of psychogenic nonepileptic seizures. Epilepsia 1995, 36:1131–1137.

    Article  PubMed  CAS  Google Scholar 

  44. Goodwin JM: Childhood sexual abuse and non-epileptic seizures. In Non-Epileptic Seizures, edn 1. Edited by AJ Rowan, JR Gates. Boston: Butterworth-Heinemann; 1993:181–191.

    Google Scholar 

  45. Torem MS: Non-epileptic seizures as a dissociative disorder. In Non-Epileptic Seizures, edn 1. Edited by AJ Rowan, JR Gates. Boston: Butterworth-Heinemann; 1993:173–179.

    Google Scholar 

  46. Barry JJ, Atzmon O: Use of hypnosis to differentiate epileptic from non-epileptic seizures. In Non-Epileptic Seizures, edn 2. Edited by JR Gates, AJ Rowan. Boston: Butterworth-Heinemann; 2000:295–303.

    Google Scholar 

  47. Lancman ME, Brotherton TA, Asconapè JJ, Penry JK: Psychogenic seizures in adults: a longitudinal analysis. Seizure 1994, 2:281–286.

    Article  Google Scholar 

  48. Betts T, Boden S: Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder, part II: previous childhood sexual abuse in the aetiology of these disorders. Seizure 1992, 1:27–32.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Psychiatry, Indiana University Epilepsy Clinic, 541 Clinical Drive, Suite 291, 46202, Indianapolis, IN, USA

    Elizabeth S. Bowman MD

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  1. Elizabeth S. Bowman MD
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Bowman, E.S. Nonepileptic seizures. Curr Treat Options Neurol 2, 559–569 (2000). https://doi.org/10.1007/s11940-000-0034-x

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