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Psychiatric classification of nonconversion nonepileptic seizures
K Alper1, O Devinsky, K Perrine
1Department of Psychiatry, New York University School of Medicine, Hospital for Joint Diseases, New York.
Archives of Neurology
|February 1, 1995
Summary
Non-conversion nonepileptic seizures (NES) are frequently associated with psychiatric disorders beyond conversion disorder, notably anxiety and psychotic disorders. Recognizing these distinctions is crucial for accurate diagnosis and treatment in epilepsy patients.
Area of Science:
- Neurology
- Psychiatry
- Epilepsy Research
Background:
- Nonepileptic seizures (NES) are often misdiagnosed, with conversion disorder being the most common psychiatric association.
- However, a significant subset of patients with nonepileptic paroxysmal events present with diverse psychiatric disorders.
- These alternative psychiatric conditions possess distinct natural histories and therapeutic approaches compared to conversion disorder.
Purpose of the Study:
- To investigate the frequency and specific types of non-conversion psychiatric disorders presenting as nonepileptic seizures (NES).
- To differentiate the demographic and historical characteristics of patients with non-conversion NES from those with conversion NES.
- To underscore the diagnostic implications of non-conversion psychiatric disorders in the context of epilepsy evaluation.
Main Methods:
- A retrospective review was conducted on consecutive admissions undergoing video-electroencephalography (VEEG) monitoring.
- All identified patients with NES were subsequently interviewed by a psychiatrist to establish psychiatric diagnoses.
- Patients were categorized into distinct groups based on the presence of conversion disorder versus other psychiatric disorders.
Main Results:
- Twenty-one patients (approximately 23% of the NES cohort) were diagnosed with psychiatric disorders other than conversion disorder.
- Anxiety disorders (DSM-III-R) were the most prevalent (n=9), followed by psychotic disorders (n=7) and impulse control issues (n=2).
- The non-conversion group lacked female predominance and reported significantly lower rates of childhood/adolescent abuse compared to conversion NES patients.
Conclusions:
- The findings support the nosological validity of distinguishing non-conversion from conversion NES.
- Anxiety disorders, as defined by DSM-III-R, represent a significant diagnostic confound in clinical epilepsy practice.
- Accurate psychiatric diagnosis is essential for appropriate management of patients presenting with nonepileptic events.