Recognition of Nonepileptic Events

ABSTRACT

Nonepileptic paroxysmal events are behavioral, motor, or sensory episodes that do not result from abnormal cortical electrical activity. They can mimic any type of epileptic seizures including simple partial, complex partial, and generalized tonic-clonic seizures. Nonepileptic paroxysmal events may be physiological or psychogenic in nature. In clinical practice, the most common imitators of epileptic seizures are syncope and psychogenic seizures, but transient ischemic attacks, migraine, movement disorders, and metabolic disturbances must be considered at times in the differential diagnosis. In most cases, the clinical history is enough to make a correct diagnosis. The clinical features suggestive of various types of nonepileptic paroxysmal events, together with useful diagnostic tests, will be reviewed.

KEYWORDS

Psychogenic seizures - epilepsy - syncope - migraine - video-EEG

REFERENCES

• 1 Benbadis S R, Tatum W O. Overinterpretation of EEGs and misdiagnosis of epilepsy.  J Clin Neurophysiol. 2003;  20 42-44
• 2 Brignole M, Alboni P, Benditt D G et al.. Guidelines on management (diagnosis and treatment) of syncope—update 2004. Executive summary.  Eur Heart J. 2004;  25 2054-2072
• 3 McKeon A, Vaughan C, Delanty N. Seizure versus syncope.  Lancet Neurol. 2006;  5 171-180
• 4 Ali S, Khan M A, Khealani B. Limb-shaking transient ischemic attacks: case report and review of literature.  BMC Neurol. 2006;  6 5
• 5 Scammell T E. The neurobiology, diagnosis, and treatment of narcolepsy.  Ann Neurol. 2003;  53 154-166
• 6 Coleman R M, Bliwise D L, Sajben N, Boomkamp A, de Bruyn L M, Dement W C. Daytime sleepiness in patients with periodic movements in sleep.  Sleep. 1982;  5(suppl 2) S191-S202
• 7 Derry C P, Duncan J S, Berkovic S F. Paroxysmal motor disorders of sleep: the clinical spectrum and differentiation from epilepsy.  Epilepsia. 2006;  47 1775-1791
• 8 Fantini M L, Corona A, Clerici S, Ferini-Strambi L. Aggressive dream content without daytime aggressiveness in REM sleep behavior disorder.  Neurology. 2005;  65 1010-1015
• 9 Bruno M K, Hallett M, Gwinn-Hardy K et al.. Clinical evaluation of idiopathic paroxysmal kinesigenic dyskinesia: new diagnostic criteria.  Neurology. 2004;  63 2280-2287
• 10 Biraben A, Taussig D, Thomas P et al.. Fear as the main feature of epileptic seizures.  J Neurol Neurosurg Psychiatry. 2001;  70 186-191
• 11 Alsaadi T M, Marquez A V. Psychogenic nonepileptic seizures.  Am Fam Physician. 2005;  72 849-856
• 12 Chabolla D R, Shih J J. Postictal behaviors associated with psychogenic nonepileptic seizures.  Epilepsy Behav. 2006;  9 307-311
• 13 Holtkamp M, Othman J, Buchheim K, Meierkord H. Diagnosis of psychogenic nonepileptic status epilepticus in the emergency setting.  Neurology. 2006;  66 1727-1729
• 14 Davis B J. Predicting nonepileptic seizures utilizing seizure frequency, EEG, and response to medication.  Eur Neurol. 2004;  51 153-156
• 15 Chen D K, So Y T, Fisher R S. Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.  Neurology. 2005;  65 668-675
• 16 Benbadis S R, O'Neill E, Tatum W O, Heriaud L. Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center.  Epilepsia. 2004;  45 1150-1153
• 17 Benbadis S R, Agrawal V, Tatum W O. How many patients with psychogenic nonepileptic seizures also have epilepsy?.  Neurology. 2001;  57 915-917
• 18 Reuber M, Fernandez G, Bauer J, Helmstaedter C, Elger C E. Diagnostic delay in psychogenic nonepileptic seizures.  Neurology. 2002;  58 493-495
• 19 Selwa L M, Geyer J, Nikakhtar N, Brown M B, Schuh L A, Drury I. Nonepileptic seizure outcome varies by type of spell and duration of illness.  Epilepsia. 2000;  41 1330-1334
• 20 Parra J, Iriarte J, Kanner A M. Are we overusing the diagnosis of psychogenic non-epileptic events?.  Seizure. 1999;  8 223-227
• 21 Iriarte J, Parra J, Urrestarazu E, Kuyk J. Controversies in the diagnosis and management of psychogenic pseudoseizures.  Epilepsy Behav. 2003;  4 354-359
• 22 Benbadis S R. Provocative techniques should be used for the diagnosis of psychogenic nonepileptic seizures.  Arch Neurol. 2001;  58 2063-2065
• 23 Parra J, Kanner A M, Iriarte J, Gil-Nagel A. When should induction protocols be used in the diagnostic evaluation of patients with paroxysmal events?.  Epilepsia. 1998;  39 863-867
• 24 McGonigal A, Russell A J, Mallik A K, Oto M, Duncan R. Use of short term video EEG in the diagnosis of attack disorders.  J Neurol Neurosurg Psychiatry. 2004;  75 771-772