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EPISODES OFTEN MISTAKEN FOR SEIZURES: PSEUDO-SEIZURES

Tuesday, April 26, 2011 11:16
Posted in category Epilepsy
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Psychological symptoms may cause intentional or subconscious episodic alterations in function or in consciousness that are mistaken for seizures but are not, in fact, of electrical origin and hence are not seizures. Although they may closely imitate seizures, such nonelectrical episodes are “pseudo-seizures.”
“I’m glad we finally got an appointment with you. Leslie’s schoolwork is deteriorating, and the medications do not seem to be helping her seizures. Ever since our divorce she has had seizures, and her doctors have tried every combination of medication. Nothing has helped. Every time she spends a weekend at her father’s house she has a seizure. She falls to the ground, flails her legs and arms, and doesn’t respond when we shout at her. I know that her EEG is abnormal. Isn’t there something you can do to help? Is she a candidate for surgery?”
Does Leslie really have seizures? It’s hard to be sure. Her doctor might ask for a more precise description of the “flailing.” He would want to check to see what abnormalities, if any, appear on the EEG. He would be suspicious that the episodes occurred only at her father’s house and began after the divorce.
As with seizures, pseudo-seizures require therapy, but therapy that is quite different from that used for “true” seizures. Our first approach would be to take a much more careful history of the events that occurred and the circumstances under which they occurred. We would also take a separate history from Leslie. “Were you taking your medicine at your father’s house? Do special things cause these episodes, for example an argument or a fight?” Depending on our sense of this story, we would try to decide whether these were real or pseudo-seizures.
Since Leslie is having problems in school, and since the medications for presumed seizures have been ineffective, we would probably decrease her medication slowly. We would also inquire about symptoms of depression that might be affecting her schoolwork and causing pseudo-seizures. If the episodes continue despite counseling, we would need to observe an episode and the simultaneous electroencephalogram to see if the episode in question is accompanied by electrical discharge from the brain. Video-EEG monitoring (see Chapter 7) can, at times, be crucial in separating true seizures from pseudo-seizures. An EEG taken during a seizure will virtually always reveal an abnormality. EEG abnormalities found between episodes do not mean that the episodes in question were seizures.
It is important to remember that a child may have true seizures and pseudo-seizures. It is vital to know which is which so that medication can be adjusted to control any true seizures and psychological counseling initiated to eliminate the pseudo-seizures.
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