Dr. Geocadin is currently at the Division of Neurosciences, Critical Care, Johns Hopkins Hospital, Baltimore, Maryland, 21287 U.S.A.
Nonepileptic Seizures After Head Injury
Article first published online: 3 AUG 2005
Volume 39, Issue 9, pages 978–982, September 1998
How to Cite
Westbrook, L. E., Devinsky, O. and Geocadin, R. (1998), Nonepileptic Seizures After Head Injury. Epilepsia, 39: 978–982. doi: 10.1111/j.1528-1157.1998.tb01447.x
- Issue published online: 3 AUG 2005
- Article first published online: 3 AUG 2005
- Accepted April 24, 1998.
- Nonepileptic seizures;
- Psychogenic seizures;
- Head trauma;
- Risk factors
Summary: Purpose: To examine the role of head injury as a risk factor in the development of nonepileptic seizures (NES). Specifically, we will determine the relative frequency of head injury among NES patients referred to our center and will describe several pertinent clinical features and personal characteristics.
Methods: Retrospective record review of patients referred to our center for evaluation of seizures over a 4-year period. All patients with NES were evaluated as in a previously described protocol, which included intensive video EEG monitoring, provocation by suggestion, and psychiatric interview. All NES patients with a history of head injury were extracted for this report.
Results: Of 102 patients with NES, nearly one-third (32%) had an antecedent head injury; 52% were male, mean age was 34 years, and 12% had coexisting epilepsy. Multiple psychiatric disorders were not uncommon (79%), and a history of abuse was found in 35%. All but four patients had documented financial gain from their injury. Follow-up at 1 year found poor long-term outcome with lasting disability; despite that, the majority (91%) of head injuries were minor.
Conclusions: Our preliminary findings suggest that prior head injury is associated with the development of NES and may contribute to the pathogenesis of NES in vulnerable patients. Head injury and sexual or physical abuse appear to occur in comparable proportions in patients with NES. This suggests that head injury and abuse may be equally important risk factors in the development of NES.