[Neuropsychiatric aspects of diagnostics of nonepileptic seizures]

The outcome of nonepileptic seizures (NES) is usually poor. The early recognition suggests better prognosis. This study is undertaken to examine the value of neuropsychiatric method for making accurate diagnosis of the psychiatric disorder that underlies psychogenic NES. Multidisciplinary approach to clinical assessment of such patients with chronic or resistant course of seizure disorder was used. Out of 6 patients, who went through the neuropsychiatric evaluation, two were admitted with a diagnosis of status epilepticus, three--with acute episodes of repetitive seizures and one--with diagnoses of bettolepsy. The results demonstrated that in four cases seizures were the manifestation of dissociative disorder (F 44), in one--of somatic form autonomic dysfunction (F 45.3) and the last patient had delirium due to epilepsy. All of the four patients with the past history of epilepsy were treated with antiepileptic drugs (AED). In two cases diagnosis of epilepsy and AED therapy were withdrawn. In the remaining cases we supposed the coexistence of epilepsy and NES. Our data suggests that incorporating of neuropsychiatric methods into the diagnostic battery for people with suspected and/or intractable epilepsy help in distinguishing NES and epilepsy as well as in revealing the underlying psychic disorder, which leads to formulation specific treatment program.