Diagnosing Non-Epileptic Seizures

Inpatient Video EEG seizure diagnosis is helpful in determining PNES from epilepsy

(RxWiki News) An epileptic seizure and non-epileptic seizure can be difficult to tell apart, even to trained doctors. Incorrect diagnosing can cause a patient to receive wrong and potentially harmful treatment.

By reviewing various diagnostic and treatment strategies for epilepsy, clinicians have determined which medications may be more helpful.

A more accurate diagnosis enables a quicker route to managing their condition.

"Review all treatment options with your doctor."

A recent study compares how clinicians in the US diagnose and treat psychogenic non-epileptic seizures (PNES) with those in Chile. The study highlights differences in treatment and diagnostic tools and suggests increasing access to video-EEG may aid in telling PNES apart from epilepsy.

Epilepsy is caused by abnormal brain cell firing and PNES is believed to be caused by psychological conditions. In Chile, clinicians often accredit PNES to anxiety while in the US, PNES is more commonly believed to come from stressors, trauma or abuse.

Epilepsy is normally treated using antiepileptic drugs. These drugs can be harmful to patients with PNES.

Treatment courses for PNES are not well defined, although cognitive behavioral therapy is believed to reduce seizures and improve other symptoms.

W. Curt LaFrance Jr., MD, MPH, of Rhode Island Hospital and colleagues administered a survey to clinicians in Chile and the US. The 20 item surveys were designed to understand diagnostic method, cause of the disease, seizure frequency, terminology, clinician’s details, patient’s disposition and any current medication.

Ninety-six Chilean surveys and 307 US surveys were returned to the researchers. The majority of responding clinicians in Chile were neurologists, followed by psychiatrists, epileptologists and neuropsychiatrists. In the US, the majority of responding clinicians were epileptologists, followed by neurologists, neuropsychologists and nurses.

Inpatient video-EEG is the normal diagnostic tool for PNES in the US. Eighty-nine percent of US respondents in this study diagnosed with video EEG, compared to 25 percent of Chilean respondents.

Inpatient video-EEG videos and records brainwaves during a patients’s seizure, allowing the event to be reviewed. While the tool is available in 95 percent of those surveyed in the US, 60 percent of Chilean respondents did not have access to it.

Sixteen percent of US respondents and 38 percent of Chilean respondents diagnose PNES by history and exam alone. History and seizure description is more likely to lead to an incorrect diagnosis.

The Chilean clinicians were more likely to endorse the use of psychoactive drugs to treat PNES than the US clinicians. The rates were 65 percent of Chilean respondents and 31 percent of US respondents.

The study was published in the journal Epilepsy & Behavior. The study was funded by the American Epilepsy Society Research and Training Workshop Award and the International League against Epilepsy Visiting Professorship in Epileptology.

The authors report no conflicts of interest.

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Review Date: 
November 8, 2012