Abstracts

RATIONALE: There is a spectrum of approaches to the intractable epilepsy patient who has both pseudoseizures (PS) and epileptic seizures (ES). At one end, PS may be regarded as a relative contraindication to surgical treatment; at the other, PS may not be addressed at all. The former approach may deny a patient a beneficial treatment option while the latter may complicate post-operative assessment, and may also prevent appropriate treatment for PS. We wished to assess an approach which included concurrent treatment of both conditions. METHODS: We developed an approach of 1)patient and family education about PS so that patient and especially family members could identify PS and ES, and 2) provided detailed explanation of a proposed treatment program which included psychotherapy and/or pharmacotherapy over 3-12 months pre-operatively, peri-operatively, and post-operatively. This approach was in use or in development during the time period reviewed. From 773 patients evaluated in the UF EMU from July 1991 to March 1999, 67 cases of ES with PS or possible PS were identified. Of these, 49 had both ES and PS; four had only ES, and for 14 there was insufficient data to definitevely establish the concurrence of PS in patients with ES. Twenty of these 49 eventually underwent resective seizure surgery. Pseudoseizures were identified in 14 of the 20 pre-operatively, and for 6/14, surgery was delayed 3-12 months. RESULTS: Among the 14 with PS identified pre-operatively, ten had 0 PS and 0 ES post-operatively; three continued to have PS. However, in the group of 6 in which PS emerged post-operatively, all continued to have PS post-operatively despite a class 1 outcome for ES for 5/6. PS were not suspected pre-operatively (although they may have occurred). CONCLUSIONS: The identification of PS pre-operatively, and subsequent appropriate treatment is an important feature of the comprehensive managment of patients with intractable epilepsy. The patient who has both ES and PS may be successfully evaluated for surgical treatment. The occurrence of PS,in and of itself, is not a contraindication to seizure surgery.