Semin Neurol 2006; 26: 341-350 DOI: 10.1055/s-2006-945520
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.
Psychogenic (Nonepileptic) Seizures
Allan Krumholz1, Jennifer Hopp1
1 Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland

ABSTRACT

Psychogenic (nonepileptic) seizures are among the most common and serious of all psychogenic neurological disorders. They account for ~20% of all intractable seizure disorders referred to comprehensive epilepsy centers and present with a reported annual incidence of ~4% that of true epilepsy. These events are serious and disabling. Indeed, compared with patients with true epilepsy, patients with psychogenic seizures exhibit more frequent, severe, and disabling seizures as well as a poorer quality of life. The diagnosis and management of psychogenic seizures remain challenging, although advances in video electroencephalographic (EEG) monitoring have improved the ability of physicians to identify these disorders accurately. The prognosis of these patients is still relatively poor, and a good outcome seems dependent on a young age at diagnosis, early diagnosis, less severe psychological comorbidities, and continued follow-up and management by the diagnosing neurologist or clinician. Additional psychological or psychiatric assessment may be beneficial, particularly in elucidating the etiology of the disorder as well as identifying comorbid disorders, and may help in the long-term management of these patients. This review presents the history, epidemiology, differential diagnosis, and management of psychogenic seizures, with particular attention to the use of diagnostic testing, including video EEG monitoring.

KEYWORDS

Nonepileptic seizures - psychogenic seizures - pseudoseizures