Hysterical seizures: Suggestion as a provocative EEG test

Abstract

We studied 57 patients with poorly controlled or atypical seizures to identify hysterical attacks with a provocative test consisting of initiation and termination of an attack with suggestion and saline injection during electroencephalographic (EEG) monitoring. Using this method, we diagnosed 48 patients as having hysterical attacks. Three additional patients had spontaneous hysterical attacks during routine recordings. Of the 51 patients with hysterical attacks, 78% were female. Two-thirds of the patients were between the ages of 20 and 35 years. Thirty-two patients had taken anticonvulsants before the study. Each patient's hysterical attack, aura, and postictum was stereotyped, and the 6 patients subject to both hysterical and organic seizures described the two types of attacks as different stereotyped behaviors. Tongue laceration, urinary incontinence, and postictal confusion were common. Twelve patients had evidence of past or present neurological disease. Abnormal EEGs were recorded in 37% but only 12% had spike or spike and wave discharges. The provocative EEG test employing saline and suggestion is a useful tool in the diagnosis of hysterical "seizures."

When Should Induction Protocols Be Used in the Diagnostic Evaluation of Patients with Paroxysmal Events?

“…The early occurrence of PNEE may reflect the fact that such patients are highly suggestible, a phenomenon observed by other investigators (16,23,30). Indeed, on the day of admission to our monitoring unit, we provide every patient a detailed explanation of what VEEG consists of, emphasizing the fact that the ultimate goal is the recording of a typical "seizure.…”

Should Patients with Psychogenic Nonepileptic Seizures be Allowed to Drive?

“…On the other hand, one could argue whether the notion of "losing consciousness" really applies to PNES, because patients are typically unresponsive but have a normal alpha rhythm (10,ll). In addition, although some injuries have been reported in PNES, significant injuries are rare (12)(13)(14)(15)(16)(17). Furthermore, reports that describe injuries in patients with PNES are largely based on patients' self-reports (15,18,19).…”

Convulsive Pseudoseizures: A Review of Current Concepts

“…A well modulated alpha rhythm preserved during intervals between movement artifact, especially in a seemingly unresponsive patient, further supports the diagnosis of pseudoseizure. Pankratz (1989) Total To increase the likelihood that an actual pseudoseizure will occur while recording in the EEG laboratory, the use of suggestion has been recommended (Cohen and Suter, 1982;Luther et at., 1982;Krumholz and Niedermeyer, 1983).…”