The approach to patients with “non-epileptic seizures”

Abstract

Up to one fifth of patients who present to specialist clinics with seizures do not have epilepsy. The majority of such patients suffer from psychologically mediated episodes; dissociative seizures, often referred to as “non-epileptic seizures”. This paper describes the diagnostic evaluation of seizure disorders, including clinical assessment and the role of special investigations. The organic and psychiatric imitators of epilepsy are outlined and findings on psychiatric assessment are reviewed. This group of patients often proves difficult to engage in appropriate treatment and an approach to explaining the diagnosis is described. As yet there are no controlled trials of treatment in this disorder but preliminary evidence suggests cognitive behavioural therapy is both a rational and promising way forward.

Diagnoses and referral pattern at a first seizure clinic in London

“…Our results also show that more than 70% of patients with NEAD had a previous psychiatric history. This observation is not obviously new (Mellers, 2005) but further reinforces the need for a comprehensive history taking, including the previous psychiatric history and the family psychiatric history, during epileptological consultations and confirms the need for Epilepsy Centres to develop integrated care pathways with local psychiatric services for the treatment of patients with NEAD. The need for integrated pathways is also supported by the proportion of patients with a first unprovoked seizure that have a previous psychiatric history (15.2%), which is not higher than the general population but definitely higher than that observed, for example, in patients with syncope (4.7%).…”

Psychogenic Nonepileptic Seizures

“…2 Before referral to a psychiatrist or other mental health professional, the neurologist may also describe a few examples of potential interventions (e.g., relaxation therapy; supportive, cognitive behavioral, and/or insightoriented approaches; explanations to the patient how this form of treatment can help. 2,[10][11][12][13][14] In some patients, the seizure frequency sometimes decreases immediately after the diagnosis is presented. I believe that this may occur because the externally focused patient reassesses the meaning of some internal somatic or emotional symptoms that the patient thought had been associated with a "seizure".…”

Evaluation of the quality of life of patients with epilepsy and patients with physchogenic non-epileptic seizures

“…ПНЕН су психолошког порекла и могу се сматрати, у већини случајева, као конверзивни (по DSM-4 класификацији), односно дисоцијативни (по MKБ-10) поре-мећај (310). Суштинска разлика између епилептичких напада и ПНЕН је у самом по-кретачу напада.…”

“…Велика је вероватноћа да се ПНЕН нађу код младих жена где се понекада покаже да је најближи члан породице вероватни починилац злостављања (310).…”

“…У процени узрока ПНЕН битно је да се не процењује само болесник, већ и његова породица, његова професионална и социјална средина, односно укупан квалитет живота (321). Код особа које имају и епилепсију и ПНЕН уз антиепилептичку терапију треба да се спроводи и психотера-пија, а код болесника без епилепсије треба постепено обуставити антиепилептичку терапију, уз детаљно информисање пацијента (310,322). Психотерапија, односно когнитивна бихејвиорална терапија се увек препоручује тамо где не постоји тежи по-ремећај личности и има велики значај у смањењу анксиозности, депресије и других психијатријских симптома (323,324).…”