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Postoperative pseudostatus: not everything that shakes is epilepsy.
M Reuber1, S M Enright, P J Goulding
1Neurology.
Anaesthesia
|December 14, 1999
Summary
Postoperative pseudoseizures are common and can be mistaken for epileptic seizures. Recognizing psychogenic non-epileptic seizures prevents harmful, inappropriate treatment in surgical patients.
Area of Science:
- Anesthesiology
- Neurology
Background:
- Postoperative epileptic seizures are rare but recognized.
- Psychogenic seizures and pseudoseizures are common, especially around surgery.
Observation:
- A series of five cases of postoperative pseudoseizures is presented.
- Failure to recognize the psychogenic nature of these seizures can lead to inappropriate treatment.
Findings:
- Psychogenic 'status' is diagnosable once considered.
- Key diagnostic signs include prolonged convulsive episodes (>90s), closed eyes during attacks, preserved pupillary response, and resistance to eye opening.
- A history of prior 'status epilepticus' admissions or postoperative 'status' is often noted.
Implications:
- Early recognition of psychogenic pseudoseizures is crucial for appropriate patient management.
- Anesthetists must be aware of these signs to avoid harmful interventions.
- Distinguishing between epileptic and psychogenic seizures prevents unnecessary and potentially dangerous treatments.