Abstracts

RATIONALE: Non-epileptic attacks (NEAs) pose diagnostic and therapeutic uncertainties. Early and correct diagnosis is important, as outcome is better if diagnosis is made early and inappropriate anti-epileptic drug treatment can be avoided. Activation procedures like saline infusion have been used for diagnostic purposes. We hypothesized that saline infusion with verbal suggestion is not only a useful diagnostic aid but has a therapeutic modality too.
METHODS: We studied 66 consecutive patients referred to the EEG laboratory by clinicians with a probable diagnosis of NEA. During the EEG an attempt was made to induce a seizure with verbal suggestion and saline infusion. If an attack was induced, the attack was stopped by verbal suggestion and using saline infusion as an anticonvulsant placebo. Patients were followed up with a postal or telephone questionnaire 4.5 years after the EEG.
RESULTS: Ages ranged from 9 to 77 years. 31 were male and 35 were female. In 41 patients saline infusion with verbal suggestion induced a NEA i.e. had a positive provocative test (PPT). Saline used as an anticonvulsant placebo stopped the seizure in all 41 patients within a minute. In 25 patients suggestion did not provoke a NEA i.e. a negative provocative test (NPT). 31 patients were followed up, of which 16 had a PPT and 15 had a NPT. NEAs were reduced in 20 patients, of which 12 were seizure free. More patients were seizure free at follow up after a PPT (7 of 16, 44%) in comparison to a NPT (5 of 15, 33 %). This was not significant (p=0.55).
CONCLUSIONS: Saline infusion with verbal suggestion can confirm the diagnosis of a NEA, and has no therapeutic effect.