Abstracts

RATIONALE: To report clinical features and associated psychiatric diagnosis in men with pseudoseizures confirmed by video-EEG monitoring. METHODS: Retrospective record review of 206 admissions to the epilepsy monitoring unit identified 50 patients with the diagnosis of pseudoseizures or psychogenic seizures. RESULTS: 34% (17/50) of the identified patients with pseudoseizures were men. Mean age was 39 years (range 16-68 years), compared to women, mean 32 (range 13-70 years). Men were also slightly older at the onset of the spells compared to women, 29 and 21 years, respectively. However, the mean duration to diagnosis was similar for men and women, 8 and 8.6 years respectively. 65% (11/17) of men were on antiepileptic medications on admission compared to 94% (31/33) of women. Nearly 50% of both groups were on polypharmacy. Prior to admission, the clinical spells averaged almost daily in men (.85/day), but were more frequent in women (1.6/day). Only 24% (4/17) had prior psychiatric diagnoses, compared to 58% (19/33) in women. The most common diagnosis in either men or women was depression (19/50). Significant psychological trauma or sexual abuse was similar in men and women, 47% (8/17) and 46% (15/33), respectively. There was no reported history of sexual abuse in men. 58% (10/17) of the patients had prominent motor components, lasting 3-5 minutes, while the remainder consisted of staring and unresponsiveness. Comparatively, 94% (31/33) of women had motor manifestations. One patient was initially admitted to the ICU with a diagnosis of Status Epilepticus. There was no incontinence or injuries during the spells. Four patients required placebo induction to evoke typical spells. There was no significant difference in the average number of spells recorded, length of time to first spell, or number of days of admission between men and women. CONCLUSIONS: Although more commonly seen in women, pseudoseizures are also common in men. Prior known psychiatric pathology was less common in men. There was no history of sexual abuse. Although most episodes simulate convulsion seizures, pseudoseizures are less commonly convulsive and less frequent in men compared to women.