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Research published to help diagnosis of psychogenic seizures

21 June, 2006

The task of
identifying psychogenic seizures (non-epileptic attack disorder) has
been highlighted in new studies published in the journal Neurology.

Research
shows that up to 30 per cent of people diagnosed with epilepsy don't
actually have the condition. They may have psychological non-epileptic
seizures, or psychogenic seizures, that are caused by psychological
conditions, not by the electrical activity in the brain that causes
epileptic seizures.

As
these non-epileptic seizures are similar to epileptic seizures, they
can be difficult to diagnose. Three new studies, it is hoped, may help
make diagnosis easier.

In the simplest of the three studies, researchers reviewed videos of 208 people whose seizures were monitored at Barrow Neurological Institute
in Phoenix. They found that 50 out of 52 (96 per cent) people with
psychological non-epileptic seizures closed their eyes during seizures,
while 152 out of 156 (97 per cent) people with epileptic seizures
opened their eyes during seizures.

Study author Dr Steve Chung commented:

"These
findings could help guide us toward the appropriate diagnosis early on.
In our experience, family members can accurately describe whether a
patient's eyes were open or closed during a seizure."

The
second study compared 26 people whose psychological non-epileptic
seizures began when they were aged 55 or older to 241 people whose
non-epileptic seizures started when they were younger than 55. The
researchers found that those with non-epileptic seizures that developed
after 55 were more likely to be male (42 per cent compared to 23 per
cent) and have severe health problems (42 per cent and 8 per cent). The
later group was more likely to report health-related traumatic
experiences (47 per cent compared to 4 per cent) and less likely to
report a history of sexual abuse (4 per cent and 32 per cent).

Research leader Dr Rod Duncan, from the West of Scotland Regional Epilepsy Service in Glasgow, said

"Our
findings suggest that the development of physical ill health,
especially when it has been frightening to the patient, may be an
important triggering factor for non-epileptic seizures in a subset of
patients."

The
third study examined 18 people treated at hospital for continuous
seizures, or status epilepticus, that did not respond to epilepsy
medication. Compared to those with epileptic seizures, those with
non-epileptic seizures were more likely to be less than 30 years old.
They were also more likely to have a 'port' system implanted for
administration of intravenous drugs and had lower blood levels of the
enzyme creatine kinase, which normally rise after epileptic seizures.

Author and neurologist Dr Martin Holtkamp, from Charité-University Medicine Berlin, commented:

"These
characteristics can help guide the emergency doctor to the correct
diagnosis, which is so critical in these cases, because the drugs can
result in severe complications if it is in fact not epilepsy. Yet an
immediate diagnosis is required, even though there is often no time to
access EEG recordings and the patient's detailed history."

In an editorial accompanying the articles, Dr Selim Bendadis wrote:

"The
need for an accurate diagnosis early on is crucial. Right now there is
an average of seven to nine years from the time someone first has these
seizures and when they are correctly diagnosed with psychological
non-epileptic seizures. During that time, they are given drugs for
epilepsy that do not treat their problem and they undergo repeated
testing - they pay a price physically, socially and financially."