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Saline infusion: a diagnostic and therapeutic tool in nonepileptic attacks?
E Wassmer1, S R Wassmer, F Donati
1Department of Neurology, University of Berne, Inselspital, CH-3010 Berne, Switzerland. e.wassmer@totalise.co.uk
Objective:
Nonepileptic attacks (NEAs) pose diagnostic and therapeutic uncertainties. Prognosis is poor. Activation procedures like saline infusion have been used for diagnostic purposes.
Method:
We reviewed 66 consecutive patients with a probable diagnosis of NEA. During the EEG an attempt was made to induce an attack with verbal suggestion and saline infusion. Patients were followed up with a postal or telephone questionnaire 4.5 years after the EEG.
Results:
Saline infusion with verbal suggestion induced in 41 of 66 patients a NEA, i.e., a positive test. Thirty-one patients were followed up. Attacks were reduced in 20 patients, of whom 12 were attack-free. More patients were attack-free at follow-up after a positive (7 of 16) in comparison to a negative (5 of 15) test.
Conclusion:
A provocative test can be diagnostic in some patients with NEA. An early and firm diagnosis may lead to appropriate treatment and better outcome.