Ictal consciousness in epilepsy and nonepileptic attack disorder
Fizzah Ali1, Hugh Rickards, Manny Bagary
1Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust and University of Birmingham, Birmingham, UK.
Epilepsy & Behavior : E&B
|October 6, 2010
Summary
Patients with nonepileptic attack disorder (NEAD) report greater awareness and more vivid experiences during attacks compared to epilepsy patients. The Ictal Consciousness Inventory (ICI) may aid differential diagnosis.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Psychology
Background:
- Differentiating epilepsy from nonepileptic attack disorder (NEAD) is clinically challenging.
- Understanding subjective seizure experiences can improve diagnostic accuracy.
Purpose of the Study:
- To quantitatively evaluate subjective consciousness during seizures in epilepsy and NEAD patients.
- To assess the utility of the Ictal Consciousness Inventory (ICI) in differential diagnosis.
Main Methods:
- A quantitative study using the Ictal Consciousness Inventory (ICI) on 95 adult outpatients with epilepsy (n=66) or NEAD (n=29).
- ICI Level (ICI-L) and ICI Content (ICI-C) scores were analyzed for 167 recalled seizures.
- Mann-Whitney U tests compared scores between epilepsy and NEAD groups.
Main Results:
- Patients with NEAD reported significantly higher ICI-L and ICI-C scores (P=0.01) compared to epilepsy patients.
- NEAD patients described greater general awareness and more vivid subjective experiences during attacks.
- Subjective consciousness reports differed significantly between the two conditions.
Conclusions:
- Subjective ictal experiences vary between epilepsy and NEAD.
- The ICI shows potential as a supplementary tool for differentiating epilepsy from NEAD.
- Further validation of the ICI in clinical practice is warranted.
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