Abstracts

Psychogenic seizures (PS) often are underdiagnosed - especially in epileptic patients.We report about 31 adolescents referred to our epilepsy center for pharmacoresistant epilepsy. We present clinical features, EEG findings, precipitants for PS, comorbidities and treatment results., 25 girls and 6 boys (aged from 12 to 23 years) with PS were identified from our inpatient records in 2003-2005. Admission diagnosis was difficult to treat epilepsy and multiple pharmacoresitance. In nearly all of them PS were not suspected. All patients had routinely EEG with sleep, hyperventilation and photostimulation. 2/3 had Video-EEG too, MRI only those with focal EEG findings. Seizures and clinical events were observed and documented (video too) by nurses and allied staff, followed by classification as epileptic or nonepileptic. Precipitating neurologic comorbidities and psychiatric diagnosis were analysed as well as the short term impact of psychotherapeutic measures., 17 patients had an active epilepsy too (9 focal, 7 generalized, 1 with focal and generalized signs). 18 patients were mentally handycapped, 9 had a positive familiy history of epilepsy. Clinically PS were clearly different from epileptic seizures and frequently dramatic. Common precipitating factors were school failure, anxiety disorder, sexual abuse and intrafamilial conflicts. A clinical setting structured by a multiprofessional team helped patients to identfy stressors, gain insight into their emotional reactions and develop coping skills (supportive milieu therapy). All patients had a significant reduction of PS. 2 were [quot]seizure free[quot] on discharge and 9 after 22 months, all of them continouing psychotherapy post discharge for 6 months minimum., Establishing a correct diagnosis is a vital step for treating PS in adolescents. Identification of stressors and early multidisciplinary stabilization yields good long term results for control of PS. Coaching the whole familiy to increase motivation for psychotherapy after discharge ameliorates the rate of seizure freedom.,