Clinical features and prognosis of non-epileptic seizures in a developing country

SILVA W, GIAGANTE B, SAIZAR R, D`ALESSIO L, ODDO S, CONSALVO D, SAIDÓN P, KOCHEN S.

EPILEPSIA

Ed Lippincott Raven

Lugar: Philadelphia; Año: 2001 vol. 42 p. 398 - 401

0013-9580

Objective: To determine the predictive value of clinical features and past medical history in patients with non-epileptic seizures (NES) Methods: 161 consecutive ictal Video-EEG’s were reviewed and 17 patients with 41 NES have been identified.  NES diagnosis was defined as paroxysmal behavioral changes suggestive of epileptic seizures recorded during Video-EEG without any electrographic ictal activity. Clinical features, age, sex, coexisting epilepsy, associated psychiatric disorder, social and economic factors, delay in reaching the diagnosis of NES, previous treatments and its correlation with outcome upon follow-up were examined. Results: The study population included 70% of female patients with a mean age of thirty-three years.  Mean duration of NES prior to diagnosis was 9 years. Forty-one percent had coexisting epilepsy. The most frequent NES clinical features were tonic-clonic mimicking movements and fear/anxiety/hyperventilation. The most common psychiatric diagnosis was Conversion Disorder and Dependent and Borderline Personality Disorder. Seventy-three percent of patients with pure NES received antiepileptic drugs (AEDs), and 63.5% of this group received new AEDs. Fifty-nine percent of the patients received psychological/ psychiatric therapy. At follow-up, 23.5% were free of NES. Conclusions: All seizure-free p. presented two good prognostic factors: having an independent life-style and the acceptance of the non-epileptic nature of the episodes. Video-EEG monitoring continues to be the diagnostic method to ensure accurate seizure classification. Establishing adequate health care programs to facilitate access to new technology in public hospitals as well as the implementation of continuous education programs for general practitioners and neurologists could eventually improve the diagnosis and treatment of patients with NES. Key words: Developing country- Non-epileptic seizures- Psychogenic seizures- Outcome- Epilepsy.