Abstracts

Mimicry between complex partial epileptic seizures (CPE) and psychogenic dissociative attacks (PDA) often leads to prolonged empirical antiepileptic drug (AED) treatment and perpetuates the unsatisfactory diagnosis of [quot]pseudoseizures[quot]. While the relationship between PDA and a range of psychiatric disorders is yet to be defined, many patients with pasttraumatic stress disorder (PTSD) exhibit PDA. The objective was to compare sleep history between patients with CPE and PDA, provisionally diagnosed as the first clinical encounter.
The investigator arrived at a single clinical diagnosis, based on detailed description of clinical events provided by the patient and, when available, the witness, the chronology of their recurrences, precipitating factors, the results of diagnostic investigations, empirical AED treatment outcome, the psychosocial background, the history of psychosexual abuse, and a review of episodic psychic symptoms. Clinical sleep symptoms were identified according to American Sleep Disorders Association (ASDA) criteria. Dream experiences were recorded as narrative summary of most emotionally charged dreams, and rated by an analog scale (no recall, non-distressing dreams, distressing dreams, and nightmare). The patient was not included, when CPE and PDA could not be differentiated, and dual diagnoses were not allowed.
Sleep history was available in 97 CPE and 119 PDA cases between 1997 and 2002. Insomnia, associated in some with daytime hypersomnia, and sleep talking were twice often seen with PDA. Contrast between 2 groups was most apparent in dream scale (Table 1). Yet, 36 (30%) of PDA patients either denied dream recall or were unable to describe dreams.
The history of psychosexual abuse was emphasized in differential diagnosis between CPE and PDA, even though the prevalence of positive history in patients with CPE has not been defined. While sleep history is more readily accessible, standardization of data collection is indicated to assure its reliability, when evaluation involves multiple interviews and multiple investigators. Further, dream scale is expected to change, reflecting impact of disabling paroxysmal symptoms. This preliminary investigation was designed to show that emotion associated could be assessed reliably, even though analysis of dream content may not assist the clinician. Multimodality diagnostic criteria of PDA can be expected to improve the clinician[apos]s confidence, when assisted by clinical neurophysiological investigations. Extended clinical monitoring with or without therapeutic interventions has led to dual diagnoses in some cases. [table1]