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Summary:Purpose: To determine whether differences in clinical manifestations of psychogenic nonepileptic events are associated with differences in outcome and whether the length of illness before diagnosis correlates with outcome.Methods: We reviewed ictal videotapes and EEGs in 85 patients diagnosed with exclusively nonepileptic psychogenic seizures during inpatient CCTV-EEG monitoring at the University of Michigan between June 1994 and December 1996. They were classified into groups of similar ictal behaviors. Fifty-seven of these patients were available to respond to a follow-up telephone survey about their condition 2 4 years after discharge. We examined demographics, baseline EEG abnormalities, and outcome of treatment interventions. We also evaluated whether interventions were more likely to succeed if patients were diagnosed early in the course of the illness.Results: We found that the largest groups consisted of patients with motionless unresponsiveness ("catatonic," n = 19) and asynchronous motor movements with impaired responsiveness ("thrashing," n = 19). Infrequent signs included tremor, automatisms, subjective events with amnesia, and intermittent behaviors. There was a higher incidence of baseline EEG abnormalities in the thrashing group (31%) than in the catatonic group (0%). There was a higher incidence of complete remission of spells in the catatonic group (53%) than in the thrashing group (21%). Patients who had a more recent onset of seizures [most often within 1 year) were much more Likely to have remission of spells after diagnosis. Conclusions: Classification of nonepileptic seizures is useful in predicting outcome and may be valuable in further investigation of this complex set of disorders. Key Words: Nonepileptic events-Outcome-Personality testing-Pseudoseizures.Carefully refined classification systems for both seizures and epilepsy syndromes have substantially improved the diagnosis and management of patients with epilepsy (1,2). These tools provide a level of detail that suggests separate etiologies and possibly even separate mechanisms of pathogenesis. A new set of revisions in these systems incorporating new knowledge is being developed (3). Observing patients with psychogenic nonepileptic spells, distinct patterns also seem to emerge. These spells are as disabling as epilepsy and tend to be even more refractory to several modes of treatment. The largest outcome study to date (4) documented a 60% refractory rate. On the basis of our observations that patients with minor motor manifestations seemed to fare better than others, we undertook this study to begin to identify potentially separate syndromes with distinguishable etiologies and natural histories.For several years, clinicians studying psychogenic nonepileptic events have discerned differences in predispositions and MMPT profiles that they believed warranted division of their groups into ''convulsive'' or %on-convulsive" patterns (3, or major versus minor motor episodes. Most patients have relatively stereotyped episodes, althou...

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The aim of this study was to determine the effects of long-term continuous cerebrocortical electrical stimulation in the treatment of partial epilepsy. The authors review the case of a 44-year-old man with medically intractable postencephalitic localization-related epilepsy with ictal onset in the primary motor cortex. For 5 years he was treated using patterned subthreshold electrical stimulation of the ictal site. This therapy has successfully eliminated the jacksonian march of cortical excitability and secondary generalization and reduced seizure frequency and intensity with an immediate postictal return of motor function. Over time, the seizure frequency subsided by more than 90%, with the patient showing no adverse features resulting from focal stimulation. The results in this case support the hypothesis that effective and safe long-term modulation of focal epilepsy is possible with focal cerebrocortical electrical stimulation.