Gender-related differences in non-epileptic attacks: a study of patients' cases in the literature

Gender-related differences for disorders of consciousness other than true epilepsy usually point to a larger number of women suffering especially from non-epileptic attacks or pseudoseizures. Recently, sexual abuse has been suggested as a possible cause for this increased prevalence in women. It has, however, not been very clear if women have a different phenomenology of these type of seizures from men. In the present study, patients' cases as published in the literature are analysed in a detailed way, using a working classification by Betts et al to look for gender-specificity. Of the 62 cases, 76% concern women and 24% men; a percentage comparable to those published elsewhere. Ages range from 14 to 77 years-of-age, but 89% of patients are younger than 40. Sexual abuse was proven in 18 cases, all women. The phenomenology of the attacks was divided into tonic-clonic type and complex partial type of attack, or a combination of the two. Also, special types of attacks (swoons, tantrums, abreactive attacks and forthright simulation) were looked for. Males tended to suffer especially from tonic-clonic type seizures (80% of cases), while in women as many tonic-clonic type as complex partial type attacks were observed. Special types of attacks were observed at the same frequency in both sexes. The group of sexual abuse victims did not differ from the total group of women in this respect. The clinically more impressive nature of a tonic-clonic-type attack, that is more easily suspected to be 'real', might make this type of seizure a more male form of acting out. A prospective study on the incidence and phenomenology of pseudo-epileptic seizures in the general population is suggested to answer the new questions raised in this survey.