Abstracts

Rationale: Over the past 20 years, in the course of our efforts to treat a large number of patients with nonepileptic seizure disorder (NESD), we used electroconvulsive treatment (ECT) only in a few cases with episodes of suicidality or psychotic features requiring hospitalization. Three of four patients were treated successfully for the episodes with a few ECTs; the most severely ill patient had to be maintained with monthly ECTs for 13 years through the present. Severity of abuse, always present in the early history, coincided with severity of the NESD. All patients with severe NESD have been female, as expected in a disorder that formerly was identified as “hysteria” (1). Our recent study of patients with both epileptic and nonepileptic seizures (2) showed that excessive treatment for epilepsy worsens the NESD, while decreasing the antiepileptic treatment and allowing the risk of some epileptic seizures results in remarkable improvement of the patients’ NESD. Consequently, we began to use ECT for patients with disabling NESD (with very frequent seizures, persistent pain, depression and anergia) in the absence of any concomitant epileptic seizures. Methods: The subjects were selected from the most severely ill and intractable patients with NESD referred to us. They received usually an initial series of six ECTs (with bifrontal stimulation) during the first 2 weeks, followed by maintenance treatment as needed.Results: Our current series of systematic use of ECT for the patients with severe intractable NESD includes 12 patients seen over the past 18 months. One patient refused further treatments after two ECTs because she had become more disturbed, and a second patient, who had improved, refused further treatments after eight ECTs because of headaches subsequent to the treatments. A third patient was relieved of her major seizures but became hesitant to continue after nine ECTs because of ill effects ascribed to the treatments. The other nine patients improved remarkably after a series of about six ECTs, but required maintenance treatments after 1 to 5 months. The therapeutic effect included a marked relief of the seizure frequency and significant improvement of pain, depressive mood and anergia; their progress at this point of follow-up can be rated from excellent to satisfactory.Conclusions: The remarkable therapeutic effect of epileptic seizures on NESD, as observed in patients with both ES and NES, is replicated by the treatment with ECT of patients with severe NESD. The polarity between the epileptic and the nonepileptic disorders in the paroxysmal disorder sphere appears akin to the well-known polarities between mania and depression in the affective sphere and between paranoia and catatonia in the schizophrenic sphere (3).