Psychogenic Seizure: Clinical Features and Psychological Analysis.
Abstract number :
2.105
Submission category :
Year :
2001
Submission ID :
113
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
A. Abubakr, MB FRCP(uk), Neurology, LSUHSC, Shreveport, LA; G. Coldato, PhD, Biometry, LSUHSC, Shreveport, LA
RATIONALE: To correlate the clinical features of Nonepileptic seizures(NES) with the underlying psychological status. In several clinical series of patients with epilepsy, relative frequency of NES is 10-40%. Correct diagnosis is important in order to avoid unnecessary treatment and it[ssquote]s potential iatrogenic hazards. Several studies, utilizing video-EEG monitoring, classify NES into attack of collapse with and without motor manifestation.
METHODS: We reviewed the video tapes and EEG recording of 23 patients with diagnosis of NES. Patients with subjective symptoms only were excluded since ictal EEG may not be apparent during simple partial seizures. Specific clinical features of each seizures were analyzed with respect to motor manifestation(upper and lower limb movement, pelvic thrusting,vocalization, head movement , and body rigidity) or being limp and unresponsive. The clinical features were divided into two categories;(1)major motor symptoms.(2)Limpness, unresponsiveness, and flaccidity. Associated psychaitric symptoms were analyzed in each subject and correlated to the clinical presentation of the seizures.
RESULTS: Thirteen patients had motor manifestation, 9 of them were women. Pelvic thrusting occured only in women(5 patients). Three men and 7 women had limpness and flaccidity during their[dsquote]seizures[dsquote]. Depression was the commonest symptom(78%)in both groups. Several patients had more than one psychiatric disturbances. There is no signifacant difference between the two groups in the frequency of depression/anxiety, PTSD, and malingering (p[gt]0.8). Six patients( 5 women and a man) had a history of sexual and physical abuse. All the patients with history of abuse presented with motor manifestation. Patients with motor manifestaion of NES have higher frequency of experiencing sexual and physical abuse compared to those with limpness(0.0%), and this difference is statistically significant(P[lt]0.05).
CONCLUSIONS: There appear to be difference in the underlying psychiatric disorder seen in patients presenting with prominent motor versus limp manifestation of NES.Those with limp manifestation are less likely to have history of sexual/physical abuse. This finding indicate that clinical manifestation of NES can help the clinician in choosing optimal psychaitric intervention