Psychogenic, Nonepileptic Seizures Associated with Video-EEG–Verified Sleep
Article first published online: 17 JAN 2003
Volume 44, Issue 1, pages 64–68, January 2003
How to Cite
Orbach, D., Ritaccio, A. and Devinsky, O. (2003), Psychogenic, Nonepileptic Seizures Associated with Video-EEG–Verified Sleep. Epilepsia, 44: 64–68. doi: 10.1046/j.1528-1157.2003.29302.x
- Issue published online: 17 JAN 2003
- Article first published online: 17 JAN 2003
- Accepted August 25, 2002.
- Nonepileptic seizures;
- Conversion disorder
Summary: Purpose: Nonepileptic seizures (NES) are expressions of a psychiatric disease state, usually conversion disorder, that mimic epileptic seizures (ES) but are not associated with the neurophysiologic changes of epilepsy. Conversion has not been demonstrated to emerge from the sleeping state. Emergence out of sleep is usually considered a virtual exclusion criterion for NES, signifying the presence instead of ES. We sought to test this hypothesis.
Methods: We retrospectively reviewed the video-EEG of all patients admitted to our epilepsy unit over a 3-year period, who were suspected of manifesting NES. We examined the relation between NES and the patients' sleep/wake state in this cohort. Two epileptologists blindly reviewed an intermixture of cases suspected to represent NES emerging out of sleep, together with control cases. Classification of each case was made independently.
Results: We found that in a small minority of patients (<1%), NES began either while the patient was sleeping, or within several seconds of arousal, well before a plan to simulate a seizure could likely have been formulated in the wakeful state.
Conclusions: In some cases, NES are not the product of the awake mind, but rather represent a psychiatric condition that can be manifest in sleep.