Abstracts

Rationale: There have been no studies to date that have reported the effect of the stress related to the September 11, 2001 terror attacks and the devastation of Hurricane Katrina on the incidence of non-epileptic seizures (NES). We report four patients who were referred for evaluation of medically-intractable complex partial seizures which commenced after 9/11 and Hurricane Katrina, whose subsequent evaluation revealed NES. Methods: Subjects were identified from a cohort of patients referred to epilepsy centers in New York City and New Orleans. All patients had been diagnosed with complex partial seizures. At the epilepsy centers, all patients had a complete history, neurological examination, electroencephalogram (EEG), epilepsy-protocol brain magnetic resonance imaging (MRI), in-patient video-EEG telemetry monitoring, and psychiatric evaluation. Results: All patients had suffered life-threatening trauma at either the World Trade Center during the terrorist attacks on September 11, 2001 (2 patients) or Hurricane Katrina (2 patients). The two 9/11 survivors also reported annual clusters of increased episodes in the weeks before and after the anniversary date of the terrorist attacks. All patients had normal neurological examinations and normal awake and asleep EEGs with activation procedures. Three out of 4 patients had normal epilepsy-protocol brain MRIs; one patient had a non-enhancing left temporal lobe lesion that was later determined to be ischemic gliosis. Three out of 4 patients had been started on anti-epileptic drugs and failed treatment. Regimens ranged from 1 to 5 medications, with an average of 2.7 drugs. All patients had characteristic events that were captured on video-EEG monitoring and were determined to be NES. Upon psychiatric evaluation, all four patients met criteria for posttraumatic stress disorder (PTSD). The median time from the start of events to diagnosis of NES was 36 months. Conclusions: Non-epileptic seizures may be a presentation of PTSD in survivors of 9/11 and Hurricane Katrina. At this time, the incidence of NES in this patient population is unknown. Non-epileptic seizures should be considered early in the differential diagnosis, particularly in patients with a poor response to medications, no clear seizure risks, or if there is an increased frequency of episodes around the anniversary date of the traumatic event. Early establishment of the correct diagnosis of non-epileptic seizures may facilitate more timely access to appropriate psychiatric therapy.