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Neuropsychology Review

, Volume 12, Issue 1, pp 31–64 | Cite as

A Review of Diagnostic Techniques in the Differential Diagnosis of Epileptic and Nonepileptic Seizures

  • Dona E. Cragar
  • David T. R. Berry
  • Toufic A. Fakhoury
  • Jean E. Cibula
  • Frederick A. Schmitt
Article

Abstract

The diagnosis of psychogenic nonepileptic seizures (PNES) is complex. Long-term electroencephalogram monitoring with video recording (video EEG) is the most common method of differential diagnosis of epilepsy and PNES. However, video EEG is complex, costly, and unavailable in some areas. Thus, alternative diagnostic techniques have been studied in the search for a diagnostic method that is as accurate as video EEG, but more cost effective, convenient, and readily available. This paper reviews the literature regarding possible diagnostic alternatives and organizes findings into 7 areas of study: demographic and medical history variables, seizure semiology, provocative testing, prolactin levels, single photon emission computed tomography, psychological testing, and neuropsychological testing. For each area, the literature is summarized, and conclusions about the accuracy of the technique as a diagnostic tool are drawn. Overall, it appears unlikely that any of the reviewed alternative techniques will replace video EEG monitoring; rather they may be more successful as complementary diagnostic tools. An important focus for further investigations involves combinations of diagnostic techniques for the differential diagnosis of epilepsy and PNES.

nonepileptic seizures epilepsy differential diagnosis neuropsychology 

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REFERENCES

  1. Abbott, R. J., Browning, M. C. K., and Davidson, D. L. W. (1980). Serum prolactin and cortisol concentrations after grand mal seizures. Journal of Neurology, Neurosurgery, and Psychiatry 43: 163–167.Google Scholar
  2. Adams, R. D., and Victor, M. (1993). Principles of neurology, 5th edn., McGraw-Hill, New York.Google Scholar
  3. Alhalabi, M. S., and Verma, N. P. (1994). Closure of eyes is a frequent and reliable sign of pseudoepileptic seizures. Epilepsia 35(Suppl. 8): 15.Google Scholar
  4. Alper, K., Devinsky, O., Perrine, K., Vazquez, B., and Luciano, D. (1993). Nonepileptic seizures and childhood sexual and physical abuse. Neurology 43: 1950–1953.Google Scholar
  5. Alving, J. (1998). Serum prolactin levels are elevated also after pseudoepileptic seizures. Seizure 7: 85–89.Google Scholar
  6. Aminoff, M. J., Simon, R. P., and Wiedemann, E. (1984). The hormonal responses to generalized tonic-clonic seizures. Brain 107: 569–578.Google Scholar
  7. Arnold, L. M., and Privitera, M. D. (1996). Psychopathology and trauma in epileptic and psychogenic seizure patients. Psychosomatics 37: 438–443.Google Scholar
  8. Austin, B. A. (1999). A comparison of verbal ability in patients with nonepileptic seizures of psychogenic origin and patients with right and left temporal lobe epilepsy. Dissertation Abstracts International 59(9): 5069B. (University Microfilms No. AAM9907650)Google Scholar
  9. Barrash, J., Gates, J. R., Heck, D. G., and Beniak, T. E. (1989). MMPI subtypes among patients with nonepileptic events. Epilepsia 30: 730–731.Google Scholar
  10. Bauer, J. (1996). Epilepsy and prolactin in adults: A clinical review. Epilepsy Research 24: 1–7.Google Scholar
  11. Bauer, J., Kaufmann, P., Elger, C. E., and Klingmuller, D. (1994). Similar postictal serum prolactin response in complex partial seizures of temporal and frontal lobe onset. Archives of Neurology 51: 645.Google Scholar
  12. Bauer, J., Stefan, H., Schrell, U., Uhlig, B., Landgraf, S., Neubauer, U., Neundorfer, B., and Burr, W. (1992). Serum prolactin prolactin concentrations and epilepsy. European Archives of Psychiatry and Clinical Neuroscience 241: 365–371.Google Scholar
  13. Bazil, C. W., Kothari, M., Luciano, D., Moroney, J., Song, S., Vasquez, B., Weinreb, H. J., and Devinsky, O. (1994). Provocation of nonepileptic seizures by suggestion in a general seizure population. Epilepsia 35: 768–770.Google Scholar
  14. Bazil, C. W., and Walczak, T. S. (1997). Effects of sleep and sleep stage on epileptic and nonepileptic seizures. Epilepsia 38: 56–62.Google Scholar
  15. Benbadis, S. R. (1999). How many patients with pseudoseizures receive antiepileptic drugs prior to diagnosis? European Neurology 41: 114–115.Google Scholar
  16. Benbadis, S. R., Agrawal, V., and Tatum, W. O. (2001). How many patients with psychogenic nonepileptic seizures also have epilepsy? Neurology 57: 915–917.Google Scholar
  17. Benbadis, S. R., and Hauser, W. A. (2000). An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure 9: 280–281.Google Scholar
  18. Benbadis, S. R., Johnson, K., Anthony, K., Caines, G., Hess, G., Jackson, C., Vale, F. L., and Tatum, W. O. (2000). Induction of psychogenic nonepileptic seizures without placebo. Neurology 55: 1904–1905.Google Scholar
  19. Benbadis, S. R., Lancman, M. E., King, L. M., and Swanson, S. J. (1996). Preictal pseudosleep: A new finding in psychogenic seizures. Neurology 47: 63–67.Google Scholar
  20. Benbadis, S. R., Wolgamuth, B. R., Goren, H., Brener, S., and Fouad-Tarazi, F. (1995). Value of tongue biting in the diagnosis of seizures. Archives of Internal Medicine 155: 2346–2349.Google Scholar
  21. Berkhoff, M., Briellmann, R. S., Radanov, B. P., Donati, F., and Hess, C. W. (1998). Developmental background and outcome in patients with nonepileptic versus epileptic seizures: A controlled study. Epilepsia 39: 463–469.Google Scholar
  22. Bhatia, M., Sinha, P. K., Jain, S., Padma, M. V., and Maheshwari, M. C. (1997). Usefulness of short-term video EEG recording with saline induction in pseudoseizures. Acta Neurologica Scandinavica 95: 363–366.Google Scholar
  23. Binder, L. M., Kindermann, S. S., Heaton, R. K., and Salinsky, M. C. (1998). Neuropsychologic impairment in patients with nonepileptic seizures. Archives of Clinical Neuropsychology 13: 513–522.Google Scholar
  24. Binder, L. M., Salinsky, M. C., and Smith, S. P. (1994). Psychological correlates of psychogenic seizures. Journal of Clinical and Experimental Neuropsychology 16: 524–530.Google Scholar
  25. Biraben, A., Taussig, D., Bernard, A. M., Vignal, J. P., Scarabin, J. M., Chauvel, P., and Duncan, R. (1999). Video EEG and ictal SPECT in three patients with both epileptic and non-epileptic seizures. Epileptic Disorders 1: 51–55.Google Scholar
  26. Blend, M. J., DeLeon, O. A., Jobe, T. H., Lin, Q., Sychra, J. J., and Gaviria, M. (1997). Cerebral perfusion SPECT imaging in epileptic and nonepileptic seizures. Clinical Nuclear Medicine 22: 363–368.Google Scholar
  27. Boon, P., DeReuck, J., Drieghe, C., DeBruycker, K., Aers, I., and Pengel, J. (1994). Long-term video-EEG monitoring revisited. European Neurology 34(Suppl. 1): 33–39.Google Scholar
  28. Boon, P., Michielsen, G., Goossens, L., Drieghe, C., D'Have, M., Buyle, M., Vonck, K., Naessens, B., DePaemeleere, F., Goethals, I., Thiery, E., Vandekerckhove, T., and DeReuck, J. (1999). Interictal and ictal video-EEG monitoring. Acta Neurologica Belgica 99: 247–255.Google Scholar
  29. Boon, P. A., and Williamson, P. D. (1993). The diagnosis of pseudoseizures. Clinical Neurology and Neurosurgery 95: 1–8.Google Scholar
  30. Bortz, J. J., Prigatano, G. P., Blum, D., and Fisher, R. S. (1995). Differential response characteristics in nonepileptic and epileptic seizure patients on a test of verbal learning and memory. Neurology 45: 2029–2034.Google Scholar
  31. Bowman, E. S. (1993). Etiology and clinical course of pseudoseizures: Relationship to trauma, depression, and dissociation. Psychosomatics 34: 333–342.Google Scholar
  32. Bowman, E. S. (1998). Pseudoseizures. The Psychiatric Clinics of North America 21: 649–657.Google Scholar
  33. Bowman, E. S. (1999). Nonepileptic seizures: Psychiatric framework, treatment, and outcome. Neurology 53(Suppl. 2): 84–88.Google Scholar
  34. Bowman, E. S. (2000). Relationship of remote and recent life events to the onset and course of non-epileptic seizures. In Gates, J. R., and Rowan, A. J. (eds.), Non-Epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 269–283.Google Scholar
  35. Bowman, E. S. (2001). Psychopathology and outcome in pseudoseizures. In Ettinger, A. B., and Kanner, A. M. (eds.), Psychiatric Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment, Lippincott, Williams, and Wilkins Publishers, Philadelphia, pp. 355–377.Google Scholar
  36. Bowman, E. S., and Markand, O. N. (1996). Psychodynamics and psychiatric diagnoses of pseudoseizure subjects. American Journal of Psychiatry 153: 57–63.Google Scholar
  37. Bowman, E. S., and Maybury, B. G. (1996). Psychiatric diagnoses and abuse histories of males with nonepileptic seizures. Epilepsia 37(Suppl. 5): 17.Google Scholar
  38. Breier, J. I., Fuchs, K. L., Brookshire, B. L., Wheless, J., Thomas, A. B., Constantinou, J., and Wilmore, L. J. (1998). Quality of life perception in patients with intractable epilepsy or pseudoseizures. Archives of Neurology 55: 660–665.Google Scholar
  39. Brown, M. C., Levin, B. E., Ramsay, R. E., Katz, D. A., and Duchowny, M. S. (1991). Characteristics of patients with nonepileptic seizures. Journal of Epilepsy 4: 225–229.Google Scholar
  40. Brown, R. J., and Trimble, M. R. (2000). Dissociative psychopathology, non-epileptic seizures, and neurology. Journal of Neurology, Neurosurgery, and Psychiatry 69: 285–288.Google Scholar
  41. Burak, J. H., Back, A. L., and Pearlman, R. A. (1997). Provoking nonepileptic seizures: The ethics of deceptive diagnostic testing. Hastings Center Report 27: 24–33.Google Scholar
  42. Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., and Kaemmer, B. (1989). Minnesota MultiphasicPersonality Inventory-2 (MMPI-2): Manual for Administration and Scoring, University of Minnesota Press, Minneapolis.Google Scholar
  43. Cardebat, D., Demonet, J. F., Viallard, G., Faure, S., Puel, S., and Celsis, P. (1996). Brain functional profiles in formal and semantic fluency tasks: A SPECT study in normals. Brain and Language 52: 305–313.Google Scholar
  44. Cartmill, A., and Betts, T. (1992). Seizure behavior in a patient with post-traumatic stress disorder following rape. Notes on the aetiology of pseudoseizures. Seizure 1: 33–36.Google Scholar
  45. Charbolla, D. R., Krahn, L. E., So, E. L., and Rummans, T. A. (1996). Psychogenic nonepileptic seizures. Mayo Clinic Proceedings 71: 493–500.Google Scholar
  46. Cohen, L. M., Howard, G. F., and Bongar, B. (1992). Provocation of pseudoseizures by psychiatric interview during EEG and video monitoring. International Journal of Psychiatry in Medicine 22: 131–140.Google Scholar
  47. Cohen, R. J., and Suter, C. (1982). Hysterical seizures: Suggestion as a provocative EEG test. Annals of Neurology 11: 391–395.Google Scholar
  48. Collins, W. C. J., Lanigan, O., and Callaghan, N. (1983). Plasma prolactin concentrations following epileptic and pseudoseizures. Journal of Neurology, Neurosurgery, and Psychiatry 46: 505–508.Google Scholar
  49. Cragar, D. E. (2000). Use of Motivational Testing as a Tool in the Diagnosis of Psychogenic Non-Epileptic Seizures, Unpublished master's thesis, University of Kentucky, Lexington.Google Scholar
  50. Cragar, D. E., Berry, D. T. R., Schmitt, F. A., Fakhoury, T. A., Cibula, J. E., and Dearth, C. M. S. (submitted). Comparison of two sets of decision rules for use with the MMPI-2 and the diagnosis of psychogenic non-epileptic seizures.Google Scholar
  51. Cragar, D. E., Chumley, W., Fakhoury, T., Cibula, J. E., Berry, D. T. R., and Schmitt, F. A. (Nov. 2001). Determination of epileptic vs. nonepileptic seizures using the MMPI-2 and behavioral characteristics. Poster session presented at the annual meeting of the National Academy of Neuropsychology, Orlando, FL.Google Scholar
  52. Cragar, D. E., Cibula, J., Fakhoury, T., Berry D. T. R., Dearth, C., Miara, C., and Schmitt, F. (Feb. 2001). Diagnosis of non-epileptic seizures: Use of the MMPI-2 and motivational tests. Poster session presented at the annual meeting of the International Neuropsychological Society, Chicago, IL.Google Scholar
  53. Dana-Haeri, J., and Trimble, M. R. (1984). Prolactin and gonadotrophin changes following partial seizures in epileptic patients with and without psychopathology. Biological Psychiatry 19: 329–336.Google Scholar
  54. Dana-Haeri, J., Trimble, M. R., and Oxley, J. (1983). Prolactin and gonadotrophin changes following generalized and partial seizures. Journal of Neurology, Neurosurgery, and Psychiatry 46: 331–335.Google Scholar
  55. DeLeon, O. A., Blend, M. J., Jobe, T. H., Ponton, M., and Gaviria, M. (1997). Application of ictal brain SPECT for differentiating epileptic from nonepileptic seizures. Journal of Neuropsychiatry and Clinical Neurosciences 9: 99–101.Google Scholar
  56. Dericioglu, N., Saygi, S., and Ciger, A. (1999). The value of provocation methods in patients suspected of having non-epileptic seizures. The Journal of the British Epilepsy Association 8: 152–156.Google Scholar
  57. Derry, P. A., and McLachlan, R. S. (1996). The MMPI-2 as an adjunct to the diagnosis of pseudoseizures. Seizure 5: 35–40.Google Scholar
  58. DeToledo, J. E., and Ramsay, R. E. (1996). Patterns of involvement of facial muscles during epileptic and nonepileptic events: Review of 654 events. Neurology 47: 621–625.Google Scholar
  59. Devinsky, O., and Fisher, R. (1996). Ethical use of placebos and provocative testing in diagnosing nonepileptic seizures. Neurology 47: 866–870.Google Scholar
  60. Devinsky, O., and Thacker, K. (1995). Nonepileptic seizures. Neurologic Clinics 13: 299–319.Google Scholar
  61. Devinsky, O., Sanchez-Villasenor, F., Vazquez, B., Kothari, M., Alper, K., and Luciano, D. (1996). Clinical profile of patients with epileptic and nonepileptic seizures. Neurology 46: 1530–1533.Google Scholar
  62. Dodrill, C. B., and Holmes, M. D. (2000). Psychological and neuropsychological evaluation of the patients with non-epileptic seizures. In Gates, J. R., and Rowan, A. J. (eds.), Non-Epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 169–181.Google Scholar
  63. Dodrill, C. B., Wilkus, R. J., and Batzel, L. W. (1993). The MMPI as a diagnostic tool in non-epileptic seizures. In Rowan, A. J., and Gates, J. R. (eds.), Nonepileptic Seizures, Butterworth-Heinemann, Boston, pp. 211–219.Google Scholar
  64. Donofrio, N., Perrine, K., Alper, K. R., and Devinsky, O. (2000). Depression and anxiety in patients with non-epileptic versus epileptic seizures. In Gates, J. R., and Rowan, A. J. (eds.), Non-Epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 151–157.Google Scholar
  65. Drake, M. E. (1985). Saline activation of pseudoepileptic seizures: Clinical EEG and neuropsychiatric observations. Clinical Electroencephalography 16: 171–176.Google Scholar
  66. Drake, M. E., Huber, S. J., Pakalnis, A., and Philips, B. B. (1993). Neuropsychological and event related potential correlates of nonepileptic seizures. The Journal of Neuropsychiatry and Clinical Neurosciences 5: 102–104.Google Scholar
  67. Ehsan, T., Fisher, R. S., Johns, D., Lukas, R. J., Blum, D., and Eskola, J. (1996). Sensitivity and specificity of paired capillary prolactin measurement in diagnosis of seizures. Journal of Epilepsy 9: 101–105.Google Scholar
  68. Eriksson, L., Larsson, S., Bergstrand, G., and Roland, P. (1986). Regional cerebral blood flow determined with single photon emission computed tomography and positron emission tomography: A comparative study. Acta Radiologica Supplementum 369: 453–455.Google Scholar
  69. Ettinger, A. B., Coyle, P. K., Jandorf, L., Cabahug, C. J., Oster, Z. H., Atkins, H. L., Weisbrot, D. M., and Devinsky, O. (1998). Postictal SPECT in epileptic versus nonepileptic seizures. Journal of Epilepsy 11: 67–73.Google Scholar
  70. Ettinger, A. B., Devinsky, O., Weisbrot, D. M., Ramakrishna, R. K., and Goyal, A. (1999). A comprehensive profile of clinical, psychiatric, and psychosocial characteristics of patients with psychogenic nonepileptic seizures. Epilepsia 40: 1292–1298.Google Scholar
  71. Ettinger, A. B., Dhoon, A., Weisbrot, D. M., and Devinsky, O. (1999). Predictive factors for outcome of nonepileptic seizures after diagnosis. The Journal of Neuropsychiatry and Clinical Neurosciences 11: 458–463.Google Scholar
  72. Finkelhor, D., Hotaling, G., Lewis, I. A., and Smith, C. (1990). Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse and Neglect 14: 19–28.Google Scholar
  73. Finlayson, R. E., and Lucas, A. R. (1979). Pseudoepileptic seizures in children and adolescents. Mayo Clinic Proceedings 54: 83–87.Google Scholar
  74. Fisher, R. S., Chan, D. W., Bare, M., and Lesser, R. P. (1991). Capillary prolactin measurement for diagnosis of seizures. Annals of Neurology 29: 187–190.Google Scholar
  75. Frances, P. L., Baker, G. A., and Appleton, P. L. (1999). Stress and avoidance in pseudoseizures: Testing the assumptions. Epilepsy Research 34: 241–249.Google Scholar
  76. Gates, J. R., and Mercer, K. (1995). Nonepileptic events. Seminars in Neurology 15: 167–174.Google Scholar
  77. Gates, J. R., Ramani, V., Whalen, S., and Loewenson, R. (1985). Ictal characteristics of pseudoseizures. Archives of Neurology 42: 1183–1187.Google Scholar
  78. Gatzonis, S. D., Siafakas, A., Chioni, A., Zournas, C., and Mantouvalos, V. (1999). Letter to the editor. Epilepsia 40: 387–389.Google Scholar
  79. Geyer, J. D., Payne, T. A., and Drury, I. (2000). The value of pelvic thrusting in the diagnosis of seizures and pseudoseizures. Neurology 54: 227–229.Google Scholar
  80. Geyer, J. D., Payne, T. A., Faught, E., and Drury, I. (1999). Postictal nose-rubbing in the diagnosis, lateralization, and localization of seizures. Neurology 52: 743–745.Google Scholar
  81. Gorey, K. M., and Leslie, D. R. (1997). The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases. Child Abuse and Neglect 21: 391–398.Google Scholar
  82. Graham, J. R. (2000). MMPI-2: Assessing Personality and Psychopathology, 3rd edn., Oxford University Press, New York.Google Scholar
  83. Green, R. L. (1991). MMPI-2/MMPI: An Interpretive Manual, Allyn and Bacon, Boston.Google Scholar
  84. Groppel, G., Kapitany, T., and Baumgartner, C. (2000). Cluster analysis of clinical seizure semiology of psychogenic nonepileptic seizures. Epilepsia 41: 610–614.Google Scholar
  85. Gross, M. (1982). Incest and hysterical seizures. Medical Hypnoanalysis 3: 146–152.Google Scholar
  86. Gross, M. (1986). Hysterical seizures-A sequel to incest during adolescence. International Journal of Adolescent Medicine and Health 2: 39–51.Google Scholar
  87. Grunwald, F., Hufnagel, A., Elger, C. E., and Biersack, H. J. (1993). Single-photon, emission-computed tomography (SPECT) in the diagnosis of epilepsy. Der Radiologe 33(4): 198–203.Google Scholar
  88. Guberman, A. (1982). Psychogenic pseudoseizures in non-epileptic patients. Canadian Journal of Psychiatry 27: 401–404.Google Scholar
  89. Hammarlund, S. (2000). The role of cognitive dysfunction in psychogenic nonepileptic seizures. Dissertation Abstracts International 60(8): 4224B. (University Microfilms No. AAI9943423)Google Scholar
  90. Hathaway, S. R., and McKinley, J. C. (1951). The Minnesota Multiphasic Personality Inventory Manual, Rev. Edn., Psychological Corporation, New York.Google Scholar
  91. Henrichs, T. F., Tucker, D. M., Farha, J., and Novelly, R. A. (1988). MMPI indices in the identification of patients evidencing pseudoseizures. Epilepsia 29: 184–187.Google Scholar
  92. Henry, T. R., and Drury, I. (1997). Non-epileptic seizures in temporal lobectomy candidates with medically refractory seizures. Neurology 48: 1374–1382.Google Scholar
  93. Hermann, B. P. (1993). Neuropsychological assessment in the diagnosis of non-epileptic seizures. In Rowan, A. J., and Gates, J. R. (eds.), Nonepileptic Seizures, Butterworth-Heineman, Boston, pp. 221–232.Google Scholar
  94. Hermann, B. P., and Connell, B. E. (1992). Neuropsychological assessment in the diagnosis of nonepileptic seizures. In Bennett, T. L. (ed.), The Neuropsychology of Epilepsy, Plenum Press, New York, pp. 59–70.Google Scholar
  95. Hoppener, R. J. E. A., Rentmeester, T. H., Arnoldussen, W., Hulsman, J., and Meijers, C. A. M. (1982). Changes in serum prolactin levels following partial and generalized seizures. British Journal of Clinical Practice 18: 193–195.Google Scholar
  96. Howell, S. J. L., Owen, L., and Chadwick, D. W. (1989). Pseudostatus epilepticus. Quarterly Journal of Medicine, New Series 266: 517–519.Google Scholar
  97. Kalogjera-Sackellares, D. (1996). Psychological disturbances in patients with pseudoseizures. In Psychological Disturbances in Epilepsy, Butterworth-Heinemann, Boston, pp. 191–217.Google Scholar
  98. Kalogjera-Sackellares, D., and Sackellares, J. C. (1997). Personality profiles of patients with pseudoseizures. Seizure 6: 1–7.Google Scholar
  99. Kalogjera-Sackellares, D., and Sackellares, J. C. (1999). Intellectual and neuropsychological features of patients with psychogenic pseudoseizures. Psychiatry Research 86: 73–84.Google Scholar
  100. Kanner, A. M. (1996). Psychogenic seizures and the supplementary sensorimotor area. In Luders, H. O. (ed.), Advances in Neurology, Vol. 70: Supplementary Motor Area, Lippincott-Raven Publishers, New York, pp. 461–466.Google Scholar
  101. Kanner, A. M., Morris, M. D., Luders, H., Dinner, D. S., Wyllie, E., Medendorp, S. V., and Rowan, A. J. (1990). Supplementary motor seizures mimicking pseudoseizures: Some clinical differences. Neurology 40: 1404–1407.Google Scholar
  102. Kanner, A. M., Palac, S. M., Lancman, M. E., Lambrakis, C. C., and Steinhardt, M. I. (2001). Treatment of psychogenic pseudoseizures: What to do after we have reached the diagnosis? In Ettinger, A. B., and Kanner, A. M. (eds.), Psychiatric Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment, Lippincott, Williams, & Wilkins Publishers, Philadelphia, pp. 379–390.Google Scholar
  103. Kanner, A. M., Parra, J., Frey, M., Stebbins, G., Pierre-Louis, S., and Iriarte, J. (1999). Psychiatric and neurologic predictors of psychogenic pseudoseizure outcome. Neurology 53: 933–938.Google Scholar
  104. Katz, A., and Spencer, S. S. (1992). The role of ictal SPECT in the diagnosis of psychogenic seizures. Epilepsia 33(Suppl. 3): 53.Google Scholar
  105. Krahn, L. E., Reese, M. M., Rummans, T. A., Peterson, G. C., Suman, T. A., Sharbrough, F. W., and Cascino, G. D. (1997). Health care utilization of patients with psychogenic nonepileptic seizures. Psychosomatics 38: 535–542.Google Scholar
  106. Kristensen, O., and Alving, J. (1992). Pseudoseizures-Risk factors and prognosis. Acta Neurologica Scandinavica 85: 177–180.Google Scholar
  107. Krumholz, A. (1999). Nonepileptic seizures: Diagnosis and management. Neurology 53(Suppl. 2): 76–83.Google Scholar
  108. Kuyk, J., Jacobs, L. D., Aldenkamp, A. P., Meinard, H., Spinhoven, P., and Van Dyck, R. (1995). Pseudoepileptic seizures: Hypnosis as a diagnostic tool. Seizure 4: 123–128.Google Scholar
  109. Kuyk, J., Leijten, F., Meinardi, H., Spinhoven, P., and Van Dyck, R. (1997). The diagnosis of psychogenic non-epileptic seizures: A review. Seizure 6: 243–253.Google Scholar
  110. Lancman, M. E., Asconape, J. J., Craven, W. J., Howard, G., and Penry, J. K. (1994). Predictive value of induction of psychogenic seizures by suggestion. Annals of Neurology 35: 359–361.Google Scholar
  111. Laxer, K. D., Mullooly, J. P., and Howell, B. (1985). Prolactin changes after seizures classified by EEG monitoring. Neurology 35: 31–35.Google Scholar
  112. Leis, A. A., Ross, M. A., and Summers, A. K. (1992). Psychogenic seizures: Ictal characteristics and diagnostic pitfalls. Neurology 42: 95–99.Google Scholar
  113. Leppik, I. (1997). Contemporary Diagnosis and Management of the Patient with Epilepsy, 3rd edn. [Brochure]. Handbooks in Health Care, Newtown, PA.Google Scholar
  114. Loring, D. W., and Meador, K. J. (2001). Cognitive and behavioral effects of epilepsy treatment. Epilepsia 42(Suppl. 8): 24–32.Google Scholar
  115. Loring, D. W., Meador, K. J., King, D. W., and Hermann, B. P. (2000). Relationship between quality of life variables and personality factors in patients with epilepsy and non-epileptic seizures. In Gates, J. R., and Rowan, A. J. (eds.), Non-Epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 159–168.Google Scholar
  116. Luther, J. S. (1987). Seizures and pseudoseizures. In Walker, J. I., Brown, J. T., and Gallis, H. A. (eds.), The Complicated Medical Patient, Human Sciences Press, New York, pp. 161–173.Google Scholar
  117. Mason, S. L., Mercer, K., Risse, G. L., and Gates, J. R. (1996). Clinical utility of the MMPI-2 in the diagnosis of non-epileptic seizures. Epilepsia 37(Suppl. 3): 18.Google Scholar
  118. Matthews, C. G., and Klove, H. (1967). Differential psychological performances in major motor, psychomotor, and mixed seizure classifications of known and unknown etiology. Epilepsia 8: 117–128.Google Scholar
  119. Matthews, C. G., Shaw, D. J., and Klove, H. (1966). Psychological test performances in neurologic and “pseudo-neurologic” subjects. Cortex 2: 244–253.Google Scholar
  120. Meador, K. J. (1994). Cognitive side effects of antiepileptic drugs. The Canadian Journal of Neurological Sciences 21(3): 12–16.Google Scholar
  121. Meador, K. J., Loring, D. W., Moore, E. E., Thompson, W. O., Nichols, M. E., Obserzan, R. E., Durkin, M. W., Gallagher, B. B., and King, D. W. (1995). Comparative cognitive effects of phenobarbital, phenytoin, and valproate in healthy adults. Neurology 45: 1494–1499.Google Scholar
  122. Meador, K. J., Loring, D. W., Ray, P. G., Murro, A. M., King, D. W., Nichols, M. E., Deer, E. M., and Goff, W. T. (1999). Differential cognitive effects of carbamazepine and gabapentin. Epilepsia 40: 1279–1285.Google Scholar
  123. Meador, K. J., Loring, D. W., Ray, P. G., Murro, A. M., King, D. W., Perrine, K. R., Vazquez, B. R., and Kiolbasa, T. (2001). Differential cognitive and behavioral effects of carbamazepine and lamotrigine. Neurology 56: 1177–1182.Google Scholar
  124. Mehta, S. R., Dham, S. K., Lazar, A. I., Narayanswamy, A. S., and Prasad, G. S. S. (1994). Prolactin and cortisol levels in seizure disorders. Journal of the Association of Physicians in India 42: 709–712.Google Scholar
  125. Meierkord, H., Shorvon, S., Lightman, S., and Trimble, M. (1992). Comparison of the effects of frontal and temporal lobe partial seizures on prolactin levels. Archives of Neurology 49: 225–230.Google Scholar
  126. Meierkord, H., Will, B., Fish, D., and Shorvon, S. (1991). The clinical features and prognosis of pseudoseizures diagnosed using video-EEG telemetry. Neurology 41: 1643–1646.Google Scholar
  127. Mohan, K. K., Markand, O. N., and Salanova, V. (1996). Diagnostic utility of video EEG monitoring in paroxysmal events. Acta Neurologica Scandinavica 94: 320–325.Google Scholar
  128. Molnar, B. E., Buka, S. L., and Kessler, R. C. (2001). Child sexual abuse and subsequent psychopathology: Results from the National Comorbidity Survey. American Journal of Public Health 91: 753–760.Google Scholar
  129. Moore, D. B., Abou-Khalil, B., and Fakhoury, T. F. (1993). Psychogenic seizures: Preictal behavior. Epilepsia 34(Suppl. 6): 1.Google Scholar
  130. Moore, D. B., Abou-Khalil, B., and Fakhoury, T. (1994). Pre-ictal behavior in psychogenic and epileptic seizures. Epilepsia 35(Suppl. 8): 51.Google Scholar
  131. Novelly, R. A. (1993). Cerebral dysfunction and cognitive impairment in non-epileptic seizure disorders. In Rowan, A. J., and Gates, J. R. (eds.), Nonepileptic Seizures, Butterworth-Heineman, Boston, pp. 233–242.Google Scholar
  132. Oxley, J., Roberts, M., Dana-Haeri, J., and Trimble, M. (1981). Evaluation of prolonged 4–channel EEG-taped recordings and serum prolactin levels in the diagnosis of epileptic and nonepileptic seizures. In Dam, M., Gram, L., and Penry, J. K. (eds.), Advances in Epileptology: XIIth Epilepsy International Symposium, Raven Press, New York, pp. 343–354.Google Scholar
  133. Pakalnis, A., Drake, M. E., and Phillips, B. (1991). Neuropsychiatric aspects of psychogenic status epilepticus. Neurology 41: 1104–1106.Google Scholar
  134. Peguero, E., Abou-Khalil, B., Fakhoury, T., and Matthews, G. (1994). Self-injury and incontinence in psychogenic seizures. Epilepsia 36: 586–591.Google Scholar
  135. Physician's Desk Reference.Available at http://www.healthandage.com/ html/res/pdr.Google Scholar
  136. Podreka, I., Lang, W., Suess, E., Wimberger, D., Steiner, M., Gradner, W., Zeitlhofer, J., Pelzl, G., Mamoli, B., and Deecke, L. (1988). Hexa-methyl-propylene-amine-oxime (HMPAO) single photon emission computed tomography (SPECT) in epilepsy. Brain Topography 1: 55–60.Google Scholar
  137. Potolicchio, S. J., Kay, G. G., and Miles, R. (1989). Minnesota Multiphasic Personality Inventory (MMPI) profiles in patients with psychogenic seizures. Neurology 39(Suppl. 1): 149–150.Google Scholar
  138. Price, H. E., Rosenbaum, D. H., Rowan, A. J., and Snyder, S. L. (1992). Measurement of regional cerebral blood flow by SPECT in nonepileptic seizure disorder patients. Epilepsia 33(Suppl. 3): 54.Google Scholar
  139. Pritchard, P. B., Wannamaker, B. B., Sagel, J., and Daniel, C. M. (1985). Serum prolactin and cortisol levels in evaluation of pseudoepileptic seizures. Annals of Neurology 18: 87–89.Google Scholar
  140. Ramani, V. (2000). Treatment of the adult patient with non-epileptic seizures. In Gates, J. R., and Rowan, A. J. (eds.), Non-epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 311–316.Google Scholar
  141. Ramani, V., and Gumnit, R. J. (1982). Intensive monitoring of interictal psychosis in epilepsy. Annals of Neurology 11: 613–622.Google Scholar
  142. Ramchandani, D., and Schindler, B. A. (1993). Distinguishing features of pseudocomplex partial seizures. Bulletin of the Menninger Clinic 56: 479–486.Google Scholar
  143. Rao, M. L., Stefan, H., and Bauer, J. (1989). Epileptic but not psychogenic seizures are accompanied by simultaneous elevation of serum pituitary hormones and cortisol levels. Neuroendocrinology 49: 33–39.Google Scholar
  144. Rechlin, T., Lowe, T. H., and Joraschky, P. (1997). Pseudoseizure “status”. Journal of Psychosomatic Research 42: 495–498.Google Scholar
  145. Reeves, A. L., McAuley, J. W., Moore, J. L., and Capestany, J. (1998). Medication use, self-reported drug allergies, and estimated medication cost in patients with epileptic versus nonepileptic seizures. Journal of Epilepsy 11: 191–194.Google Scholar
  146. Reuber, M., Enright, S. M., and Goulding, P. J. (2000). Postoperative pseudostatus. Anaesthesia 55: 70–78.Google Scholar
  147. Risse, G. L., Mason, S. L., and Mercer, D. K. (2000). Neuropsychological performance and cognitive complaints in epileptic and nonepileptic seizure patients. In Gates, J. R., and Rowan, A. J. (eds.), Non-epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 139–150.Google Scholar
  148. Rodrigues, M., Botelho, M. M., Fonseca, A. T., Peter, J. P., Pimentel, T., and Vieira, M. R. (1996). Combined study of 99mTc-HMPAO SPECT and computerized electroencephalographic topography (CET) in patients with medically refractory complex partial epilepsy. Annals of Nuclear Medicine 10: 113–118.Google Scholar
  149. Rosenberg, H. J., Rosenberg, S. D., Williamson, P. D., and Wolford, G. L. (2000). A comparative study of trauma and posttraumatic stress disorder prevalence in epilepsy patients and psychogenic nonepileptic seizure patients. Epilepsia 41: 447–452.Google Scholar
  150. Rosenbaum, M. (2000). Psychogenic seizures-Why women? Psychosomatics 41: 147–149.Google Scholar
  151. Roy, A. (1989). Pseudoseizures: Psychiatric perspective. Journal of Neuropsychiatry 1: 69–71.Google Scholar
  152. Sackellares, J. C., Giordani, B., Berent, S., Seidenberg, F. E., Dreifuss, F. E., Vanderzant, C. W., and Boll, T. J. (1985). Patients with pseudoseizures: Intellectual and cognitive performance. Neurology 35: 116–119.Google Scholar
  153. Sagyi, S., Katz, A., Marks, D. A., and Spencer, S. S. (1992). Frontal lobe partial seizures and psychogenic seizures: Comparison of clinical and ictal characteristics. Neurology 42: 1274–1277.Google Scholar
  154. Salloway, S., and White, J. (1997). Paroxysmal limbic disorder in neuropsychiatry. The Journal of Neuropsychiatry and Clinical Neurosciences 9: 403–419.Google Scholar
  155. Savard, G., and Andermann, F. (1990). Convulsive pseudoseizures: A review of current concepts. Behavioural Neurology 3: 133–141.Google Scholar
  156. Schachter, S. C., Brown, F., and Rowan, A. J. (1996). Provocative testing for nonepileptic seizures: Attitudes and practices in the United States among American Epilepsy Society members. Journal of Epilepsy 9: 249–252.Google Scholar
  157. Schlaug, G., and Patel, M. (1997). Radiographic assessment of patients with epilepsy. In Schachter, S. C., and Schomer, D. L. (eds.), The Comprehensive Evaluation and Treatment of Epilepsy: A Practical Guide, Academic Press, New York, pp. 37–59.Google Scholar
  158. Schramke, C., Valeriano, J., and Kelly, K. (Feb. 2001). Predicting pseudoseizures using routine EEG, the MMPI, and years of seizures: A replication. Poster session presented at the annual meeting of the International Neuropsychological Society, Chicago, IL.Google Scholar
  159. Silva, W., Giagante, B., Saizar, R., D'Alessio, L., Oddo, S., Consalvo, D., Saidon, P., and Kochen, S. (2001). Clinical features and prognosis of nonepileptic seizures in a developing country. Epilepsia 42: 398–401.Google Scholar
  160. Singh, U. K., and Jana, U. K. (1994). Plasma prolactin in epilepsy and pseudoseizures. Indian Pediatrics 31: 667–669.Google Scholar
  161. Shaw, D. J. (1966). Differential MMPI performance in pseudo-seizure, epileptic and pseudo-neurologic groups. Journal of Clinical Psychology 22: 271–275.Google Scholar
  162. Shaw, D. J., and Matthews, C. G. (1965). Differential MMPI performance of brain-damaged vs. pseudo-neurologic groups. Journal of Clinical Psychology 21: 405–408.Google Scholar
  163. Shen, W., Bowman, E. S., and Markand, O. N. (1990a). Presenting the diagnosis of pseudoeseizure. Neurology 40: 756–759.Google Scholar
  164. Shen, W., Bowman, E. S., and Markand, O. N. (1990b). Pseudoeseizures. Neurology 40: 1478–1479.Google Scholar
  165. Slater, J. D., Brown, M. C., Jacobs, W., and Ramsay, R. E. (1995). Induction of pseudoseizures with intravenous saline placebo. Epilepsia 36: 580–585.Google Scholar
  166. Smith, C. A., Saykin, A. J., Riordan, H. J., Flashman, L. A., and Williamson, P. D. (1997a). Neuropsychological differentiation of psychogenic versus frontal lobe epilepsy. The Journal of Neuropsychiatry and Clinical Neurosciences 9(1): 169.Google Scholar
  167. Smith, M. L., Stagno, S. J., Dolske, M., Kosalko, J., McConnell, C., Kaspar, L., and Lederman, R. (1997b). Induction procedures for psychogenic seizures: Ethical and clinical consideration. The Journal of Clinical Ethics 8: 217–229.Google Scholar
  168. Spanaki, M. V., Spencer, S. S., Corsi, M., MacMullan, J., Seibyl, J., and Zubal, I. G. (1999). The role of quantitative ictal SPECT analysis in the evaluation of nonepileptic seizures. Journal of Neuroimaging 9: 210–216.Google Scholar
  169. Stagno, S. J., and Smith, M. L. (1996). Use of induction procedures in diagnosing psychogenic seizures. Journal of Epilepsy 9: 153–158.Google Scholar
  170. Stagno, S. J., and Smith, M. L. (1997). The use of placebo in diagnosing psychogenic seizures: Who is being deceived? Seminars in Neurology 17: 213–218.Google Scholar
  171. Steinberg, J. L., Devous, M. D., and Paulman, R. G. (1996). Wisconsin card sorting activated regional cerebral blood flow in first break and chronic schizophrenic patients and normal controls. Schizophrenia Research 19: 177–187.Google Scholar
  172. Stewart, R. S., Lovitt, R., and Stewart, R. M. (1982). Are hysterical seizures more than hysteria? A research diagnostic criteria, DSM-III, and psychometric analysis. American Journal of Psychiatry 139: 926–929.Google Scholar
  173. Storzbach, D., Binder, L. M., Salinsky, M. C., Campbell, B. R., and Mueller, R. M. (2000). Improved prediction of nonepileptic seizures with combined MMPI and EEG measures. Epilepsia 41: 332–337.Google Scholar
  174. Swanson, S. J., Springer, J. A., Benbadis, S. R., and Morris, G. L. (2000). Cognitive and psychological functioning in patients with non-epileptic seizures. In Gates, J. R., and Rowan, A. J. (Eds.), Non-Epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp.123–137.Google Scholar
  175. Szaflarski, J. P., Ficker, D. M., Cahill, W. T., and Privitera, M. D. (2000). Four-year incidence of psychogenic nonepileptic seizures in adults in Hamilton County, OH. Neurology 55: 1561–1563.Google Scholar
  176. Tatum, W. O., Chheda, H., and Easton, T. S. (1993). SPECT during suggestion of nonepileptic seizures. Epilepsia 34(Suppl. 6): 61.Google Scholar
  177. Thacker, K., Devinsky, O., Perrine, K., Alper, K., and Luciano, D. (1993). Nonepileptic seizures during apparent sleep. Annals of Neurology 33: 414–418.Google Scholar
  178. Thompson, P. M., Batzel, L. W., and Wilkus, R. J. (1992). Millon clinical multiaxial inventory assessment of patients manifesting either psychogenic or epileptic seizures. Journal of Epilepsy 5: 226–230.Google Scholar
  179. Tojek, T. M., Lumley, M., Barkley, G., Mahr, G., and Thomas, A. (2000). Stress and other psychosocial characteristics of patients with psychogenic nonepileptic seizures. Psychosomatics 41: 221–226.Google Scholar
  180. Trimble, M. R. (1978). Serum prolactin in epilepsy and hysteria. BMJ 16: 1682.Google Scholar
  181. Trimble, M. R., Dana-Haeri, J., Oxley, J., and Baylis, P. H. (1984). Some neuroendocrine consequences of seizures. In Porter, R. J. (ed.), Advances in Epileptology: XVth Epilepsy International Symposium, Raven Press, New York, pp. 201–208.Google Scholar
  182. Trimble, M. R., Ring, H. A., and Schmitz, B. (1996). Neuropsychiatric aspects of epilepsy. In Fogel, B. S., Schiffer, R. B., and Rao, S. M. (eds.), Neuropsychiatry, Williams and Wilkins, Baltimore, MD, pp. 771–803.Google Scholar
  183. Vanderzant, C. W., Giordani, B., Berent, S., Dreifuss, F. E., and Sackellares, J. C. (1986). Personality of patients with pseudoseizures. Neurology 36: 664–668.Google Scholar
  184. Varma, A. R., Moriarty, J., Costa, D. C., Gacinovic, S., Schmitz, E. B., Ell, P. J., and Trimble, M. R. (1996). HMPAO SPECT in non-epileptic seizures: Preliminary results. Acta Neurologica Scandinavica 94: 88–92.Google Scholar
  185. Walczak, T. S., Williams, D. T., and Berten,W. (1994). Utility and reliability of placebo infusion in the evaluation of patients with seizures. Neurology 44: 394–399.Google Scholar
  186. Warner, M. H., Wilkus, R. J., Vossler, D. G., Wyler, A. R., and Abson-Kraemer, D. L. (1996). MMPI-2 profiles in differential diagnosis of epilepsy vs psychogenic seizures. Epilepsia 37(Suppl. 5): 19.Google Scholar
  187. Weil, S., Noachtar, S., Arnold, S., Yousry, T. A., Winkler, P. A., and Tatsch, K. (2001). Ictal ECD-SPECT differentiates between temporal and extratemporal epilepsy: Confirmation by excellent postoperative seizure control. Nuclear Medicine Communications 22: 233–237.Google Scholar
  188. Westbrook, L. E., Devinsky, O., and Geocadin, R. (1998). Nonepileptic seizures after head injury. Epilepsia 39: 978–982.Google Scholar
  189. Wheless, J. W., Galan, A., Barron, B. J., Tran, H. D., Willmore, J., Curtis, V. L., and Lamki, L. M. (1993). Nonepileptic seizures: Diagnostic verification with ictal and interictal SPECT. Epilepsia 34(Suppl. 2): 140.Google Scholar
  190. Wilkus, R. J., and Dodrill, C. B. (1989). Factors affecting the outcome of MMPI and neuropsychological assessments of psychogenic and epileptic seizure patients. Epilepsia 30: 339–347.Google Scholar
  191. Wilkus, R. J., Dodrill, C. B., and Thompson, P. M. (1984). Intensive EEG monitoring and psychological studies of patients with pseudoepileptic seizures. Epilepsia 25: 100–107.Google Scholar
  192. Wilkus, R. J., Thompson, P. M., and Vossler, D. G. (1990). Bizarre ictal automatisms: Frontal lobe epileptic or psychogenic seizures? Journal of Epilepsy 3: 207–213.Google Scholar
  193. Willmore, L. J., Wheless, J. W., Curtis, V. L., Barron, B. J., Tran, H. D., and Fletcher, J. M. (1992). SPECT abnormalities in patients with nonepileptic seizures. Epilepsia 33(Suppl. 3): 53–54.Google Scholar
  194. Wood, B. L., McDaniel, S., Burchfiel, K., and Erba, G. (1998). Factors distinguishing families of patients with psychogenic seizures from families of patients with epilepsy. Epilepsia 39: 432–437.Google Scholar
  195. Wyllie, E., Luders, H., MacMillan, J. P., and Gupta, M. (1984). Serum prolactin levels after epileptic seizures. Neurology 34: 1601–1604.Google Scholar
  196. Zaidi, A., Crampton, S., Clough, P., Fitzpatrick, A., and Scheepers, B. (1999). Head-up tilting is a useful provocative test for psychogenic non-epileptic seizures. Seizure 8: 353–355.Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Dona E. Cragar
    • 1
  • David T. R. Berry
    • 1
  • Toufic A. Fakhoury
    • 2
  • Jean E. Cibula
    • 2
    • 3
  • Frederick A. Schmitt
    • 4
    • 5
  1. 1.Department of PsychologyUniversity of Kentucky Medical CenterLexington
  2. 2.Department of NeurologyUniversity of Kentucky Medical CenterLexington
  3. 3.Mount Carmel Medical CenterColumbus
  4. 4.Departments of Neurology, Psychiatry, Psychology, and Behavioral ScienceUniversity of Kentucky Medical CenterLexington
  5. 5.Sanders-Brown Center on AgingUniversity of Kentucky Medical CenterLexington

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