Frequency of epilepsy in patients with psychogenic seizures monitored by video-EEG

The withdrawal of antiepileptic drugs in patients with non-epileptic seizures: safety considerations

The majority of patients with psychogenic non-epileptic seizures (PNES) do not have epilepsy. There are a number of compelling reasons to take these patients off antiepileptic drugs (AEDs), including drug toxicity and teratogenicity, as well as possibly poorer outcome of PNES and increased risk of iatrogenic harm when patients present to emergency rooms on AEDs as emergencies. However, many patients with PNES who do not have epilepsy remain on AEDs postdiagnosis. Some studies do report patients taken off medication as an outcome measure, but with no assessment of the safety of withdrawal, or specification of the criteria for 'excluding' epilepsy. One study has assessed the safety of taking patients satisfying some simple criteria for the absence of an underlying epilepsy off AEDs, and has found the procedure to be safe, given appropriate postwithdrawal follow-up. Patients with PNES who do not have evidence of epilepsy should be referred to a centre with appropriate expertise in epilepsy diagnosis so that AEDs can be withdrawn in safe conditions.

The opinion of the general practitioner toward clinical management of patients with psychogenic nonepileptic seizures

OBJECTIVE

The purpose of this work was to assess the opinion of general practitioners (GPs) regarding the diagnosis of psychogenic nonepileptic seizures (PNES) and the role they feel they should play in the management of the disorder.

METHODS

Patients with PNES were identified from hospital records. Seizure and patient characteristics were recorded. Their GPs were surveyed regarding their understanding of the diagnosis and ongoing management of PNES.

RESULTS

Twenty-three patients were identified over a 3-year period as having been diagnosed with PNES. Sixty-five percent of GPs agreed with the diagnosis, and when asked to grade their understanding of the diagnosis (poor = 1, excellent = 10), the mean score was 5.7 (+/-SD 2.3). Thirty-five percent of GPs felt psychological input was of benefit to their patients. Fifty-two percent of GPs felt comfortable following up these patients, either with or without neurology outpatient services.

CONCLUSIONS

PNES remains a difficult disease to manage. There is a high level of uncertainty regarding the optimum management of PNES among primary care physicians, for which further education is needed.

Comorbidité psychiatrique au cours des événements non épileptiques : étude rétrospective dans un centre de vidéo-EEG

INTRODUCTION

Pseudoseizures involve a group of paroxysmal behavioral symptoms mimicking an epileptic seizure, but without modifications of cerebral electrical activity.

PATIENTS AND METHOD

In this retrospective study focusing on mental disorders, 37 patients with pseudoseizures were recorded during video-EEG procedure.

RESULTS

According to DSM-IV criteria, 70 percent of the patients had at least one mental disorder when evaluated. Diagnoses were, in decreasing order of frequency: post-traumatic stress disorders, other anxious disorders, somatoform disorders, dissociative disorders, and mood disorders.

CONCLUSION

The strong association between pseudoseizures and post-traumatic stress disorders is discussed. Our results argue in favor of a systematic evaluation of psychiatric comorbidity.