Psychogenic non-epileptic seizures
2559158
197321853
2008-03-10T20:55:22Z
Mattisse
1386816
/* External links */ add cat
{{DiseaseDisorder infobox |
Name = Psychogenic non-epileptic seizures |
ICD10 = F44.5 |
ICD9 = {{ICD9|300.11}}, {{ICD9|780.39}} |
}}
'''Psychogenic non-epileptic seizures''' are a manifestation or a form of [[conversion disorder]].<ref>[http://www.emedicine.com/EMERG/topic112.htm eMedicine - Conversion Disorder : Article by Seth Powsner<!-- Bot generated title -->]</ref> They take many forms, and particularly can mimic any sort of [[epileptic seizure]]; they are distinguished from [[epilepsy]] only in that they are not associated with abnormal, rhythmic discharges of cortical [[neuron]]s.<ref>[http://www.emedicine.com/neuro/topic403.htm eMedicine - Psychogenic Nonepileptic Seizures : Article by Selim R Benbadis, MD<!-- Bot generated title -->]</ref> The condition is not benign; people have broken bones, crashed automobiles, bitten off parts of their tongue, and even died from injuries sustained during non-epileptic seizures.{{Fact|date=February 2007}}
An older term, '''pseudoseizures''', is deprecated.<ref name=NSE>[http://www.e-epilepsy.org.uk/pages/articles/show_article.cfm?id=48 Diagnosis and management of dissociative seizures], John DC Mellers, The National Society for Epilepsy, September 2005.</ref> While it is correct that a non-epileptic seizure may resemble an epileptic seizure, [[pseudo]] can also connote "false, fraudulent, or pretending to be something that it is not." Non-epileptic seizures are not false, fraudulent, or produced under any sort of pretense.
==Diagnosis==
Confounding [[neurology|neurologists]] and other [[physician]]s, psychogenic non-epileptic seizures are frequently misdiagnosed as [[epilepsy]]; less frequently, the reverse is true. Misdiagnosis means that appropriate treatments are not received by the patient. In addition, the former misdiagnosis is dangerous because it can result in administration of unnecessary (and even potentially harmful) medication; the latter because a person with epilepsy is not correctly treated with medication that could help them. Statistics on the [[prevalence]] of these misdiagnoses are not available.
Certain features suggest the presence of PNES, including the presence of [[tears]], which are uncommon in epileptic seizures,<ref name="pmid8215964">{{cite journal |author=Bergen D, Ristanovic R |title=Weeping as a common element of pseudoseizures |journal=[[Arch. Neurol.]] |volume=50 |issue=10 |pages=1059–60 |year=1993 |pmid=8215964 |doi=}}</ref> and a tendency for attacks to occur when other people are present, but not during sleep or while alone.
Inpatient hospitalization for [[long-term Video-EEG monitoring|long term video-EEG monitoring]] is a costly but effective way to distinguish them from [[epileptic seizure]]s. They tend not to respond to anticonvulsant medications. Also, many persons with epilepsy experience non-epileptic seizures as well; finding evidence of one does not rule out the presence of the other.
Many physicians measure serum [[prolactin]] levels in patients who may have non-epileptic seizures, because serum levels of prolactin are often elevated just following an epileptic seizure, returning to normal within 15 minutes.<ref>[http://professionals.epilepsy.com/page/hormones_postictal.html Postictal prolactin testing : Epilepsy.com/Professionals<!-- Bot generated title -->]</ref><ref>Wyllie E, Luders H, Macmillan JP, et al. Serum prolactin levels after epileptic seizures. Neurology. 1984;34:1601-1604.</ref> Still, a negative prolactin does not rule out epileptic seizures (Ahmad & Beckett 2004). Also, individuals with non-epileptic seizures may have elevated prolactin levels for other reasons, including intercurrent epilepsy and medication side effects.{{Fact|date=February 2007}}
==Treatment==
The patient with '''psychogenic non-epileptic seizures''' is sometimes found to give a history of childhood [[physical abuse]] or [[sexual abuse]] or other severe emotional [[Psychological trauma|trauma]]. (Betts, 1997.) Treatment based on insight-oriented techniques or exploring of abuse histories has not been found to be effective.
Instead, treatment with [[cognitive therapy]] or [[behavioral therapy]] is focused on concrete strategies to recognize the triggers of the seizures and use techniques to control them and eventually halt the onset.<ref>[http://serendip.brynmawr.edu/bb/neuro/neuro03/web2/nthirugnanam.html The Hysteria Over Conversion Disorder | Serendip's Exchange<!-- Bot generated title -->]</ref><ref>[http://ajp.psychiatryonline.org/cgi/content/full/164/1/7 Randomized Controlled Trials and Psychotherapy Research - Rifkin 164 (1): 7 - Am J Psychiatry<!-- Bot generated title -->]</ref><ref>[http://www.mayoclinic.com/health/conversion-disorder/AN00622 Conversion disorder - MayoClinic.com<!-- Bot generated title -->]</ref><ref>http://healthgate.partners.org/browsing/LearningCenter.asp?fileName=96743.xml&title=</ref><ref>[http://www.neuropsychiatryreviews.com/jul04/npr_jul04_psychogenic.html Psychotherapy Effective in Treating Psychogenic Movement Disorders<!-- Bot generated title -->]</ref>
==See also==
*[[Non-epileptic seizures]]
*[[hystero-epilepsy]]
*[[Functional Neurological Deficit]]
*[[Somatoform disorder]]
==Notes==
<References/>
==References==
* Ahmad S, Beckett MW. ''Value of serum prolactin in the management of syncope.'' Emerg Med J 2004;21:e3. [http://emj.bmjjournals.com/cgi/content/full/21/2/e3 Fulltext]. PMID 14988379.
* Betts, T. "Chapter 265: Conversion Disorders." In ''Epilepsy, a Comprehensive Textbook'', ed. Engel, J., and Pedley, T, Lippincott-Raven, Philadelphia, 1997.
==External links==
*[http://www.non-epilepticseizures.com Centralized web site for Psychogenic Nonepileptic Seizures]
*[http://www.neuropsychiatryreviews.com/jul04/npr_jul04_psychogenic.html Article in Neuropsychiatry news] This article has statistical research data which suggests that non-epileptic seizures can be dramatically improved with psychotherapy.
*[http://www.epilepsyfoundation.org/answerplace/Medical/seizures/types/nonepileptic/weinonepilepsy.cfm Epilepsy Foundation article about non-epileptic seizures]
*[http://www.epilepsy.com/articles/ar_1112967056.html Epilepsy.com article about non-epileptic seizures]
*[http://www.e-epilepsy.org.uk/pages/articles/show_article.cfm?id=48 National Society for Epilepsy (UK) article on Non-epileptic attack disorder]. A slightly more technical article aimed at health professionals.
[[Category:Symptoms]]
[[Category:Neurological disorders]]
[[Category:Abnormal psychology]]