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Nonepileptic posttraumatic seizures

E Barry1, A Krumholz, G K Bergey

  • 1The Maryland Epilepsy Center and the Department of Neurology, University of Maryland School of Medicine, Baltimore, USA.

Epilepsia
|May 13, 1998
PubMed
Summary

A significant portion of nonepileptic seizures (NESs) are mistakenly attributed to head injuries (HI). Many patients with NESs following mild HI experience severe disability, highlighting the need for careful evaluation.

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Area of Science:

  • Neurology
  • Trauma Research

Background:

  • Epileptic posttraumatic seizures (PTSs) are a known outcome of head injury (HI).
  • The relationship between HI and nonepileptic seizures (NESs) has not been previously established.
  • This study identifies a notable group of patients with NESs whose seizures were linked to a prior HI.

Purpose of the Study:

  • To investigate the occurrence and characteristics of NESs attributed to head injury.
  • To differentiate NESs from epileptic PTSs in patients with a history of HI.
  • To highlight the diagnostic challenges and consequences of misdiagnosing NESs after HI.

Main Methods:

  • A retrospective review of patients diagnosed with NES at a major medical center from 1989 to 1995.
  • Selection criteria included patients with seizures attributed to an HI within three years prior to seizure onset.

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  • Video-electroencephalogram (EEG) confirmation of NES was required.

    • Main Results:

    • Out of 157 patients with confirmed NES, 37 (24%) reported seizures originating after an HI.
    • The majority of these patients (78%) had experienced only mild HI, contrasting with typical epileptic PTSs following severe HI.
    • Nonepileptic PTSs led to significant disability, with only 11% able to continue previous activities.

    Conclusions:

    • Nonepileptic PTSs are often misdiagnosed as epileptic seizures, leading to ineffective treatments and significant patient disability.
    • Patients presenting with intractable seizures after HI, especially mild HI, warrant thorough evaluation for NESs.
    • Early and accurate diagnosis of NESs is crucial for appropriate management and to prevent long-term functional impairment.