Abstracts

RATIONALE: Objective: At the end of this presentation participants should be aware that nonepileptic seizures (NES) may occur in middle-aged men.
Characteristically, NES occur in young adults and are disproportionately weighted toward young women. Our study examines the occurrence of NES in middle-aged men and characterizes the clinical characteristics of their NES events. Methods of precipitating NES are examined. Comparison is made with age matched controls with epileptic seizures (ES) in terms of education, employment status, and the effects of diagnosis on subsequent employment. All patients attended an outpatient epilepsy clinic at the Ralph H. Johnson DVA Medical Center, Charleston, SC.
METHODS: VEEG confirmed a diagnosis of NES in 11 men. Demographic data from the study group and from consecutively derived, age-matched controls with ES were compared. Methods of inducing NES were noted, and behavioral characteristics of NES events were classified by type. Patients and sometimes eyewitnesses viewed VEEG events to verify that the recorded events represented their characteristic attacks.
RESULTS: Men with NES ranged from 33 to 73 years of age (55 +/- 12 years). The most common features of NES were convulsive (bilateral in 4 and focal in 3), followed by altered responsiveness (5 cases). Other NES behaviors included tachypnea (3), visual hallucinations (1), and piloerection (1). Some patients had multiple NES types. Some attacks occurred spontaneously (4), while others were provoked by suggestion plus hyperventilation (3) or suggestion alone (2). Two cases were precipitated by reenactment of an inciting event.
NES patients often had previous psychiatric diagnosis (55%) or a history of ethanol abuse (18%). ES patients had higher levels of educational attainment (11 +/- 3 years, versus 9 +/- 4 years for those with NES). Those with ES were also more likely to be employed (27%, versus 18% for NES). After the diagnosis of NES, one additional man obtained employment. Patients with NES continued to experience their typical attacks, but for the most part they found the experience to be less distressing after the diagnosis was made and explained to them.
CONCLUSIONS: Although adults with NES are typically young women, middle-aged men also experience NES. Convulsive events, either focal or generalized, are the most common manifestation of NES in the latter group. Men with NES have lower educational attainment and higher unemployment status than age-matched controls with ES. Although diagnosis of NES did not lead to cessation of the attacks, patients found them to be less distressing after they understood the diagnosis.