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A Review of Diagnostic Techniques in the Differential Diagnosis of Epileptic and Nonepileptic Seizures

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Abstract

The diagnosis of psychogenic nonepileptic seizures (PNES) is complex. Long-term electroencephalogram monitoring with video recording (video EEG) is the most common method of differential diagnosis of epilepsy and PNES. However, video EEG is complex, costly, and unavailable in some areas. Thus, alternative diagnostic techniques have been studied in the search for a diagnostic method that is as accurate as video EEG, but more cost effective, convenient, and readily available. This paper reviews the literature regarding possible diagnostic alternatives and organizes findings into 7 areas of study: demographic and medical history variables, seizure semiology, provocative testing, prolactin levels, single photon emission computed tomography, psychological testing, and neuropsychological testing. For each area, the literature is summarized, and conclusions about the accuracy of the technique as a diagnostic tool are drawn. Overall, it appears unlikely that any of the reviewed alternative techniques will replace video EEG monitoring; rather they may be more successful as complementary diagnostic tools. An important focus for further investigations involves combinations of diagnostic techniques for the differential diagnosis of epilepsy and PNES.

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REFERENCES

  • Abbott, R. J., Browning, M. C. K., and Davidson, D. L. W. (1980). Serum prolactin and cortisol concentrations after grand mal seizures. Journal of Neurology, Neurosurgery, and Psychiatry 43: 163–167.

    Google Scholar 

  • Adams, R. D., and Victor, M. (1993). Principles of neurology, 5th edn., McGraw-Hill, New York.

    Google Scholar 

  • Alhalabi, M. S., and Verma, N. P. (1994). Closure of eyes is a frequent and reliable sign of pseudoepileptic seizures. Epilepsia 35(Suppl. 8): 15.

    Google Scholar 

  • Alper, K., Devinsky, O., Perrine, K., Vazquez, B., and Luciano, D. (1993). Nonepileptic seizures and childhood sexual and physical abuse. Neurology 43: 1950–1953.

    Google Scholar 

  • Alving, J. (1998). Serum prolactin levels are elevated also after pseudoepileptic seizures. Seizure 7: 85–89.

    Google Scholar 

  • Aminoff, M. J., Simon, R. P., and Wiedemann, E. (1984). The hormonal responses to generalized tonic-clonic seizures. Brain 107: 569–578.

    Google Scholar 

  • Arnold, L. M., and Privitera, M. D. (1996). Psychopathology and trauma in epileptic and psychogenic seizure patients. Psychosomatics 37: 438–443.

    Google Scholar 

  • Austin, B. A. (1999). A comparison of verbal ability in patients with nonepileptic seizures of psychogenic origin and patients with right and left temporal lobe epilepsy. Dissertation Abstracts International 59(9): 5069B. (University Microfilms No. AAM9907650)

    Google Scholar 

  • Barrash, J., Gates, J. R., Heck, D. G., and Beniak, T. E. (1989). MMPI subtypes among patients with nonepileptic events. Epilepsia 30: 730–731.

    Google Scholar 

  • Bauer, J. (1996). Epilepsy and prolactin in adults: A clinical review. Epilepsy Research 24: 1–7.

    Google Scholar 

  • Bauer, J., Kaufmann, P., Elger, C. E., and Klingmuller, D. (1994). Similar postictal serum prolactin response in complex partial seizures of temporal and frontal lobe onset. Archives of Neurology 51: 645.

    Google Scholar 

  • Bauer, J., Stefan, H., Schrell, U., Uhlig, B., Landgraf, S., Neubauer, U., Neundorfer, B., and Burr, W. (1992). Serum prolactin prolactin concentrations and epilepsy. European Archives of Psychiatry and Clinical Neuroscience 241: 365–371.

    Google Scholar 

  • Bazil, C. W., Kothari, M., Luciano, D., Moroney, J., Song, S., Vasquez, B., Weinreb, H. J., and Devinsky, O. (1994). Provocation of nonepileptic seizures by suggestion in a general seizure population. Epilepsia 35: 768–770.

    Google Scholar 

  • Bazil, C. W., and Walczak, T. S. (1997). Effects of sleep and sleep stage on epileptic and nonepileptic seizures. Epilepsia 38: 56–62.

    Google Scholar 

  • Benbadis, S. R. (1999). How many patients with pseudoseizures receive antiepileptic drugs prior to diagnosis? European Neurology 41: 114–115.

    Google Scholar 

  • Benbadis, S. R., Agrawal, V., and Tatum, W. O. (2001). How many patients with psychogenic nonepileptic seizures also have epilepsy? Neurology 57: 915–917.

    Google Scholar 

  • Benbadis, S. R., and Hauser, W. A. (2000). An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure 9: 280–281.

    Google Scholar 

  • Benbadis, S. R., Johnson, K., Anthony, K., Caines, G., Hess, G., Jackson, C., Vale, F. L., and Tatum, W. O. (2000). Induction of psychogenic nonepileptic seizures without placebo. Neurology 55: 1904–1905.

    Google Scholar 

  • Benbadis, S. R., Lancman, M. E., King, L. M., and Swanson, S. J. (1996). Preictal pseudosleep: A new finding in psychogenic seizures. Neurology 47: 63–67.

    Google Scholar 

  • Benbadis, S. R., Wolgamuth, B. R., Goren, H., Brener, S., and Fouad-Tarazi, F. (1995). Value of tongue biting in the diagnosis of seizures. Archives of Internal Medicine 155: 2346–2349.

    Google Scholar 

  • Berkhoff, M., Briellmann, R. S., Radanov, B. P., Donati, F., and Hess, C. W. (1998). Developmental background and outcome in patients with nonepileptic versus epileptic seizures: A controlled study. Epilepsia 39: 463–469.

    Google Scholar 

  • Bhatia, M., Sinha, P. K., Jain, S., Padma, M. V., and Maheshwari, M. C. (1997). Usefulness of short-term video EEG recording with saline induction in pseudoseizures. Acta Neurologica Scandinavica 95: 363–366.

    Google Scholar 

  • Binder, L. M., Kindermann, S. S., Heaton, R. K., and Salinsky, M. C. (1998). Neuropsychologic impairment in patients with nonepileptic seizures. Archives of Clinical Neuropsychology 13: 513–522.

    Google Scholar 

  • Binder, L. M., Salinsky, M. C., and Smith, S. P. (1994). Psychological correlates of psychogenic seizures. Journal of Clinical and Experimental Neuropsychology 16: 524–530.

    Google Scholar 

  • Biraben, A., Taussig, D., Bernard, A. M., Vignal, J. P., Scarabin, J. M., Chauvel, P., and Duncan, R. (1999). Video EEG and ictal SPECT in three patients with both epileptic and non-epileptic seizures. Epileptic Disorders 1: 51–55.

    Google Scholar 

  • Blend, M. J., DeLeon, O. A., Jobe, T. H., Lin, Q., Sychra, J. J., and Gaviria, M. (1997). Cerebral perfusion SPECT imaging in epileptic and nonepileptic seizures. Clinical Nuclear Medicine 22: 363–368.

    Google Scholar 

  • Boon, P., DeReuck, J., Drieghe, C., DeBruycker, K., Aers, I., and Pengel, J. (1994). Long-term video-EEG monitoring revisited. European Neurology 34(Suppl. 1): 33–39.

    Google Scholar 

  • Boon, P., Michielsen, G., Goossens, L., Drieghe, C., D'Have, M., Buyle, M., Vonck, K., Naessens, B., DePaemeleere, F., Goethals, I., Thiery, E., Vandekerckhove, T., and DeReuck, J. (1999). Interictal and ictal video-EEG monitoring. Acta Neurologica Belgica 99: 247–255.

    Google Scholar 

  • Boon, P. A., and Williamson, P. D. (1993). The diagnosis of pseudoseizures. Clinical Neurology and Neurosurgery 95: 1–8.

    Google Scholar 

  • Bortz, J. J., Prigatano, G. P., Blum, D., and Fisher, R. S. (1995). Differential response characteristics in nonepileptic and epileptic seizure patients on a test of verbal learning and memory. Neurology 45: 2029–2034.

    Google Scholar 

  • Bowman, E. S. (1993). Etiology and clinical course of pseudoseizures: Relationship to trauma, depression, and dissociation. Psychosomatics 34: 333–342.

    Google Scholar 

  • Bowman, E. S. (1998). Pseudoseizures. The Psychiatric Clinics of North America 21: 649–657.

    Google Scholar 

  • Bowman, E. S. (1999). Nonepileptic seizures: Psychiatric framework, treatment, and outcome. Neurology 53(Suppl. 2): 84–88.

    Google Scholar 

  • Bowman, E. S. (2000). Relationship of remote and recent life events to the onset and course of non-epileptic seizures. In Gates, J. R., and Rowan, A. J. (eds.), Non-Epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 269–283.

    Google Scholar 

  • Bowman, E. S. (2001). Psychopathology and outcome in pseudoseizures. In Ettinger, A. B., and Kanner, A. M. (eds.), Psychiatric Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment, Lippincott, Williams, and Wilkins Publishers, Philadelphia, pp. 355–377.

    Google Scholar 

  • Bowman, E. S., and Markand, O. N. (1996). Psychodynamics and psychiatric diagnoses of pseudoseizure subjects. American Journal of Psychiatry 153: 57–63.

    Google Scholar 

  • Bowman, E. S., and Maybury, B. G. (1996). Psychiatric diagnoses and abuse histories of males with nonepileptic seizures. Epilepsia 37(Suppl. 5): 17.

    Google Scholar 

  • Breier, J. I., Fuchs, K. L., Brookshire, B. L., Wheless, J., Thomas, A. B., Constantinou, J., and Wilmore, L. J. (1998). Quality of life perception in patients with intractable epilepsy or pseudoseizures. Archives of Neurology 55: 660–665.

    Google Scholar 

  • Brown, M. C., Levin, B. E., Ramsay, R. E., Katz, D. A., and Duchowny, M. S. (1991). Characteristics of patients with nonepileptic seizures. Journal of Epilepsy 4: 225–229.

    Google Scholar 

  • Brown, R. J., and Trimble, M. R. (2000). Dissociative psychopathology, non-epileptic seizures, and neurology. Journal of Neurology, Neurosurgery, and Psychiatry 69: 285–288.

    Google Scholar 

  • Burak, J. H., Back, A. L., and Pearlman, R. A. (1997). Provoking nonepileptic seizures: The ethics of deceptive diagnostic testing. Hastings Center Report 27: 24–33.

    Google Scholar 

  • Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., and Kaemmer, B. (1989). Minnesota MultiphasicPersonality Inventory-2 (MMPI-2): Manual for Administration and Scoring, University of Minnesota Press, Minneapolis.

    Google Scholar 

  • Cardebat, D., Demonet, J. F., Viallard, G., Faure, S., Puel, S., and Celsis, P. (1996). Brain functional profiles in formal and semantic fluency tasks: A SPECT study in normals. Brain and Language 52: 305–313.

    Google Scholar 

  • Cartmill, A., and Betts, T. (1992). Seizure behavior in a patient with post-traumatic stress disorder following rape. Notes on the aetiology of pseudoseizures. Seizure 1: 33–36.

    Google Scholar 

  • Charbolla, D. R., Krahn, L. E., So, E. L., and Rummans, T. A. (1996). Psychogenic nonepileptic seizures. Mayo Clinic Proceedings 71: 493–500.

    Google Scholar 

  • Cohen, L. M., Howard, G. F., and Bongar, B. (1992). Provocation of pseudoseizures by psychiatric interview during EEG and video monitoring. International Journal of Psychiatry in Medicine 22: 131–140.

    Google Scholar 

  • Cohen, R. J., and Suter, C. (1982). Hysterical seizures: Suggestion as a provocative EEG test. Annals of Neurology 11: 391–395.

    Google Scholar 

  • Collins, W. C. J., Lanigan, O., and Callaghan, N. (1983). Plasma prolactin concentrations following epileptic and pseudoseizures. Journal of Neurology, Neurosurgery, and Psychiatry 46: 505–508.

    Google Scholar 

  • Cragar, D. E. (2000). Use of Motivational Testing as a Tool in the Diagnosis of Psychogenic Non-Epileptic Seizures, Unpublished master's thesis, University of Kentucky, Lexington.

    Google Scholar 

  • Cragar, D. E., Berry, D. T. R., Schmitt, F. A., Fakhoury, T. A., Cibula, J. E., and Dearth, C. M. S. (submitted). Comparison of two sets of decision rules for use with the MMPI-2 and the diagnosis of psychogenic non-epileptic seizures.

  • Cragar, D. E., Chumley, W., Fakhoury, T., Cibula, J. E., Berry, D. T. R., and Schmitt, F. A. (Nov. 2001). Determination of epileptic vs. nonepileptic seizures using the MMPI-2 and behavioral characteristics. Poster session presented at the annual meeting of the National Academy of Neuropsychology, Orlando, FL.

  • Cragar, D. E., Cibula, J., Fakhoury, T., Berry D. T. R., Dearth, C., Miara, C., and Schmitt, F. (Feb. 2001). Diagnosis of non-epileptic seizures: Use of the MMPI-2 and motivational tests. Poster session presented at the annual meeting of the International Neuropsychological Society, Chicago, IL.

  • Dana-Haeri, J., and Trimble, M. R. (1984). Prolactin and gonadotrophin changes following partial seizures in epileptic patients with and without psychopathology. Biological Psychiatry 19: 329–336.

    Google Scholar 

  • Dana-Haeri, J., Trimble, M. R., and Oxley, J. (1983). Prolactin and gonadotrophin changes following generalized and partial seizures. Journal of Neurology, Neurosurgery, and Psychiatry 46: 331–335.

    Google Scholar 

  • DeLeon, O. A., Blend, M. J., Jobe, T. H., Ponton, M., and Gaviria, M. (1997). Application of ictal brain SPECT for differentiating epileptic from nonepileptic seizures. Journal of Neuropsychiatry and Clinical Neurosciences 9: 99–101.

    Google Scholar 

  • Dericioglu, N., Saygi, S., and Ciger, A. (1999). The value of provocation methods in patients suspected of having non-epileptic seizures. The Journal of the British Epilepsy Association 8: 152–156.

    Google Scholar 

  • Derry, P. A., and McLachlan, R. S. (1996). The MMPI-2 as an adjunct to the diagnosis of pseudoseizures. Seizure 5: 35–40.

    Google Scholar 

  • DeToledo, J. E., and Ramsay, R. E. (1996). Patterns of involvement of facial muscles during epileptic and nonepileptic events: Review of 654 events. Neurology 47: 621–625.

    Google Scholar 

  • Devinsky, O., and Fisher, R. (1996). Ethical use of placebos and provocative testing in diagnosing nonepileptic seizures. Neurology 47: 866–870.

    Google Scholar 

  • Devinsky, O., and Thacker, K. (1995). Nonepileptic seizures. Neurologic Clinics 13: 299–319.

    Google Scholar 

  • Devinsky, O., Sanchez-Villasenor, F., Vazquez, B., Kothari, M., Alper, K., and Luciano, D. (1996). Clinical profile of patients with epileptic and nonepileptic seizures. Neurology 46: 1530–1533.

    Google Scholar 

  • Dodrill, C. B., and Holmes, M. D. (2000). Psychological and neuropsychological evaluation of the patients with non-epileptic seizures. In Gates, J. R., and Rowan, A. J. (eds.), Non-Epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 169–181.

    Google Scholar 

  • Dodrill, C. B., Wilkus, R. J., and Batzel, L. W. (1993). The MMPI as a diagnostic tool in non-epileptic seizures. In Rowan, A. J., and Gates, J. R. (eds.), Nonepileptic Seizures, Butterworth-Heinemann, Boston, pp. 211–219.

    Google Scholar 

  • Donofrio, N., Perrine, K., Alper, K. R., and Devinsky, O. (2000). Depression and anxiety in patients with non-epileptic versus epileptic seizures. In Gates, J. R., and Rowan, A. J. (eds.), Non-Epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 151–157.

    Google Scholar 

  • Drake, M. E. (1985). Saline activation of pseudoepileptic seizures: Clinical EEG and neuropsychiatric observations. Clinical Electroencephalography 16: 171–176.

    Google Scholar 

  • Drake, M. E., Huber, S. J., Pakalnis, A., and Philips, B. B. (1993). Neuropsychological and event related potential correlates of nonepileptic seizures. The Journal of Neuropsychiatry and Clinical Neurosciences 5: 102–104.

    Google Scholar 

  • Ehsan, T., Fisher, R. S., Johns, D., Lukas, R. J., Blum, D., and Eskola, J. (1996). Sensitivity and specificity of paired capillary prolactin measurement in diagnosis of seizures. Journal of Epilepsy 9: 101–105.

    Google Scholar 

  • Eriksson, L., Larsson, S., Bergstrand, G., and Roland, P. (1986). Regional cerebral blood flow determined with single photon emission computed tomography and positron emission tomography: A comparative study. Acta Radiologica Supplementum 369: 453–455.

    Google Scholar 

  • Ettinger, A. B., Coyle, P. K., Jandorf, L., Cabahug, C. J., Oster, Z. H., Atkins, H. L., Weisbrot, D. M., and Devinsky, O. (1998). Postictal SPECT in epileptic versus nonepileptic seizures. Journal of Epilepsy 11: 67–73.

    Google Scholar 

  • Ettinger, A. B., Devinsky, O., Weisbrot, D. M., Ramakrishna, R. K., and Goyal, A. (1999). A comprehensive profile of clinical, psychiatric, and psychosocial characteristics of patients with psychogenic nonepileptic seizures. Epilepsia 40: 1292–1298.

    Google Scholar 

  • Ettinger, A. B., Dhoon, A., Weisbrot, D. M., and Devinsky, O. (1999). Predictive factors for outcome of nonepileptic seizures after diagnosis. The Journal of Neuropsychiatry and Clinical Neurosciences 11: 458–463.

    Google Scholar 

  • Finkelhor, D., Hotaling, G., Lewis, I. A., and Smith, C. (1990). Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse and Neglect 14: 19–28.

    Google Scholar 

  • Finlayson, R. E., and Lucas, A. R. (1979). Pseudoepileptic seizures in children and adolescents. Mayo Clinic Proceedings 54: 83–87.

    Google Scholar 

  • Fisher, R. S., Chan, D. W., Bare, M., and Lesser, R. P. (1991). Capillary prolactin measurement for diagnosis of seizures. Annals of Neurology 29: 187–190.

    Google Scholar 

  • Frances, P. L., Baker, G. A., and Appleton, P. L. (1999). Stress and avoidance in pseudoseizures: Testing the assumptions. Epilepsy Research 34: 241–249.

    Google Scholar 

  • Gates, J. R., and Mercer, K. (1995). Nonepileptic events. Seminars in Neurology 15: 167–174.

    Google Scholar 

  • Gates, J. R., Ramani, V., Whalen, S., and Loewenson, R. (1985). Ictal characteristics of pseudoseizures. Archives of Neurology 42: 1183–1187.

    Google Scholar 

  • Gatzonis, S. D., Siafakas, A., Chioni, A., Zournas, C., and Mantouvalos, V. (1999). Letter to the editor. Epilepsia 40: 387–389.

    Google Scholar 

  • Geyer, J. D., Payne, T. A., and Drury, I. (2000). The value of pelvic thrusting in the diagnosis of seizures and pseudoseizures. Neurology 54: 227–229.

    Google Scholar 

  • Geyer, J. D., Payne, T. A., Faught, E., and Drury, I. (1999). Postictal nose-rubbing in the diagnosis, lateralization, and localization of seizures. Neurology 52: 743–745.

    Google Scholar 

  • Gorey, K. M., and Leslie, D. R. (1997). The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases. Child Abuse and Neglect 21: 391–398.

    Google Scholar 

  • Graham, J. R. (2000). MMPI-2: Assessing Personality and Psychopathology, 3rd edn., Oxford University Press, New York.

    Google Scholar 

  • Green, R. L. (1991). MMPI-2/MMPI: An Interpretive Manual, Allyn and Bacon, Boston.

    Google Scholar 

  • Groppel, G., Kapitany, T., and Baumgartner, C. (2000). Cluster analysis of clinical seizure semiology of psychogenic nonepileptic seizures. Epilepsia 41: 610–614.

    Google Scholar 

  • Gross, M. (1982). Incest and hysterical seizures. Medical Hypnoanalysis 3: 146–152.

    Google Scholar 

  • Gross, M. (1986). Hysterical seizures-A sequel to incest during adolescence. International Journal of Adolescent Medicine and Health 2: 39–51.

    Google Scholar 

  • Grunwald, F., Hufnagel, A., Elger, C. E., and Biersack, H. J. (1993). Single-photon, emission-computed tomography (SPECT) in the diagnosis of epilepsy. Der Radiologe 33(4): 198–203.

    Google Scholar 

  • Guberman, A. (1982). Psychogenic pseudoseizures in non-epileptic patients. Canadian Journal of Psychiatry 27: 401–404.

    Google Scholar 

  • Hammarlund, S. (2000). The role of cognitive dysfunction in psychogenic nonepileptic seizures. Dissertation Abstracts International 60(8): 4224B. (University Microfilms No. AAI9943423)

  • Hathaway, S. R., and McKinley, J. C. (1951). The Minnesota Multiphasic Personality Inventory Manual, Rev. Edn., Psychological Corporation, New York.

    Google Scholar 

  • Henrichs, T. F., Tucker, D. M., Farha, J., and Novelly, R. A. (1988). MMPI indices in the identification of patients evidencing pseudoseizures. Epilepsia 29: 184–187.

    Google Scholar 

  • Henry, T. R., and Drury, I. (1997). Non-epileptic seizures in temporal lobectomy candidates with medically refractory seizures. Neurology 48: 1374–1382.

    Google Scholar 

  • Hermann, B. P. (1993). Neuropsychological assessment in the diagnosis of non-epileptic seizures. In Rowan, A. J., and Gates, J. R. (eds.), Nonepileptic Seizures, Butterworth-Heineman, Boston, pp. 221–232.

    Google Scholar 

  • Hermann, B. P., and Connell, B. E. (1992). Neuropsychological assessment in the diagnosis of nonepileptic seizures. In Bennett, T. L. (ed.), The Neuropsychology of Epilepsy, Plenum Press, New York, pp. 59–70.

    Google Scholar 

  • Hoppener, R. J. E. A., Rentmeester, T. H., Arnoldussen, W., Hulsman, J., and Meijers, C. A. M. (1982). Changes in serum prolactin levels following partial and generalized seizures. British Journal of Clinical Practice 18: 193–195.

    Google Scholar 

  • Howell, S. J. L., Owen, L., and Chadwick, D. W. (1989). Pseudostatus epilepticus. Quarterly Journal of Medicine, New Series 266: 517–519.

    Google Scholar 

  • Kalogjera-Sackellares, D. (1996). Psychological disturbances in patients with pseudoseizures. In Psychological Disturbances in Epilepsy, Butterworth-Heinemann, Boston, pp. 191–217.

    Google Scholar 

  • Kalogjera-Sackellares, D., and Sackellares, J. C. (1997). Personality profiles of patients with pseudoseizures. Seizure 6: 1–7.

    Google Scholar 

  • Kalogjera-Sackellares, D., and Sackellares, J. C. (1999). Intellectual and neuropsychological features of patients with psychogenic pseudoseizures. Psychiatry Research 86: 73–84.

    Google Scholar 

  • Kanner, A. M. (1996). Psychogenic seizures and the supplementary sensorimotor area. In Luders, H. O. (ed.), Advances in Neurology, Vol. 70: Supplementary Motor Area, Lippincott-Raven Publishers, New York, pp. 461–466.

    Google Scholar 

  • Kanner, A. M., Morris, M. D., Luders, H., Dinner, D. S., Wyllie, E., Medendorp, S. V., and Rowan, A. J. (1990). Supplementary motor seizures mimicking pseudoseizures: Some clinical differences. Neurology 40: 1404–1407.

    Google Scholar 

  • Kanner, A. M., Palac, S. M., Lancman, M. E., Lambrakis, C. C., and Steinhardt, M. I. (2001). Treatment of psychogenic pseudoseizures: What to do after we have reached the diagnosis? In Ettinger, A. B., and Kanner, A. M. (eds.), Psychiatric Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment, Lippincott, Williams, & Wilkins Publishers, Philadelphia, pp. 379–390.

    Google Scholar 

  • Kanner, A. M., Parra, J., Frey, M., Stebbins, G., Pierre-Louis, S., and Iriarte, J. (1999). Psychiatric and neurologic predictors of psychogenic pseudoseizure outcome. Neurology 53: 933–938.

    Google Scholar 

  • Katz, A., and Spencer, S. S. (1992). The role of ictal SPECT in the diagnosis of psychogenic seizures. Epilepsia 33(Suppl. 3): 53.

    Google Scholar 

  • Krahn, L. E., Reese, M. M., Rummans, T. A., Peterson, G. C., Suman, T. A., Sharbrough, F. W., and Cascino, G. D. (1997). Health care utilization of patients with psychogenic nonepileptic seizures. Psychosomatics 38: 535–542.

    Google Scholar 

  • Kristensen, O., and Alving, J. (1992). Pseudoseizures-Risk factors and prognosis. Acta Neurologica Scandinavica 85: 177–180.

    Google Scholar 

  • Krumholz, A. (1999). Nonepileptic seizures: Diagnosis and management. Neurology 53(Suppl. 2): 76–83.

    Google Scholar 

  • Kuyk, J., Jacobs, L. D., Aldenkamp, A. P., Meinard, H., Spinhoven, P., and Van Dyck, R. (1995). Pseudoepileptic seizures: Hypnosis as a diagnostic tool. Seizure 4: 123–128.

    Google Scholar 

  • Kuyk, J., Leijten, F., Meinardi, H., Spinhoven, P., and Van Dyck, R. (1997). The diagnosis of psychogenic non-epileptic seizures: A review. Seizure 6: 243–253.

    Google Scholar 

  • Lancman, M. E., Asconape, J. J., Craven, W. J., Howard, G., and Penry, J. K. (1994). Predictive value of induction of psychogenic seizures by suggestion. Annals of Neurology 35: 359–361.

    Google Scholar 

  • Laxer, K. D., Mullooly, J. P., and Howell, B. (1985). Prolactin changes after seizures classified by EEG monitoring. Neurology 35: 31–35.

    Google Scholar 

  • Leis, A. A., Ross, M. A., and Summers, A. K. (1992). Psychogenic seizures: Ictal characteristics and diagnostic pitfalls. Neurology 42: 95–99.

    Google Scholar 

  • Leppik, I. (1997). Contemporary Diagnosis and Management of the Patient with Epilepsy, 3rd edn. [Brochure]. Handbooks in Health Care, Newtown, PA.

    Google Scholar 

  • Loring, D. W., and Meador, K. J. (2001). Cognitive and behavioral effects of epilepsy treatment. Epilepsia 42(Suppl. 8): 24–32.

    Google Scholar 

  • Loring, D. W., Meador, K. J., King, D. W., and Hermann, B. P. (2000). Relationship between quality of life variables and personality factors in patients with epilepsy and non-epileptic seizures. In Gates, J. R., and Rowan, A. J. (eds.), Non-Epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 159–168.

    Google Scholar 

  • Luther, J. S. (1987). Seizures and pseudoseizures. In Walker, J. I., Brown, J. T., and Gallis, H. A. (eds.), The Complicated Medical Patient, Human Sciences Press, New York, pp. 161–173.

    Google Scholar 

  • Mason, S. L., Mercer, K., Risse, G. L., and Gates, J. R. (1996). Clinical utility of the MMPI-2 in the diagnosis of non-epileptic seizures. Epilepsia 37(Suppl. 3): 18.

    Google Scholar 

  • Matthews, C. G., and Klove, H. (1967). Differential psychological performances in major motor, psychomotor, and mixed seizure classifications of known and unknown etiology. Epilepsia 8: 117–128.

    Google Scholar 

  • Matthews, C. G., Shaw, D. J., and Klove, H. (1966). Psychological test performances in neurologic and “pseudo-neurologic” subjects. Cortex 2: 244–253.

    Google Scholar 

  • Meador, K. J. (1994). Cognitive side effects of antiepileptic drugs. The Canadian Journal of Neurological Sciences 21(3): 12–16.

    Google Scholar 

  • Meador, K. J., Loring, D. W., Moore, E. E., Thompson, W. O., Nichols, M. E., Obserzan, R. E., Durkin, M. W., Gallagher, B. B., and King, D. W. (1995). Comparative cognitive effects of phenobarbital, phenytoin, and valproate in healthy adults. Neurology 45: 1494–1499.

    Google Scholar 

  • Meador, K. J., Loring, D. W., Ray, P. G., Murro, A. M., King, D. W., Nichols, M. E., Deer, E. M., and Goff, W. T. (1999). Differential cognitive effects of carbamazepine and gabapentin. Epilepsia 40: 1279–1285.

    Google Scholar 

  • Meador, K. J., Loring, D. W., Ray, P. G., Murro, A. M., King, D. W., Perrine, K. R., Vazquez, B. R., and Kiolbasa, T. (2001). Differential cognitive and behavioral effects of carbamazepine and lamotrigine. Neurology 56: 1177–1182.

    Google Scholar 

  • Mehta, S. R., Dham, S. K., Lazar, A. I., Narayanswamy, A. S., and Prasad, G. S. S. (1994). Prolactin and cortisol levels in seizure disorders. Journal of the Association of Physicians in India 42: 709–712.

    Google Scholar 

  • Meierkord, H., Shorvon, S., Lightman, S., and Trimble, M. (1992). Comparison of the effects of frontal and temporal lobe partial seizures on prolactin levels. Archives of Neurology 49: 225–230.

    Google Scholar 

  • Meierkord, H., Will, B., Fish, D., and Shorvon, S. (1991). The clinical features and prognosis of pseudoseizures diagnosed using video-EEG telemetry. Neurology 41: 1643–1646.

    Google Scholar 

  • Mohan, K. K., Markand, O. N., and Salanova, V. (1996). Diagnostic utility of video EEG monitoring in paroxysmal events. Acta Neurologica Scandinavica 94: 320–325.

    Google Scholar 

  • Molnar, B. E., Buka, S. L., and Kessler, R. C. (2001). Child sexual abuse and subsequent psychopathology: Results from the National Comorbidity Survey. American Journal of Public Health 91: 753–760.

    Google Scholar 

  • Moore, D. B., Abou-Khalil, B., and Fakhoury, T. F. (1993). Psychogenic seizures: Preictal behavior. Epilepsia 34(Suppl. 6): 1.

    Google Scholar 

  • Moore, D. B., Abou-Khalil, B., and Fakhoury, T. (1994). Pre-ictal behavior in psychogenic and epileptic seizures. Epilepsia 35(Suppl. 8): 51.

    Google Scholar 

  • Novelly, R. A. (1993). Cerebral dysfunction and cognitive impairment in non-epileptic seizure disorders. In Rowan, A. J., and Gates, J. R. (eds.), Nonepileptic Seizures, Butterworth-Heineman, Boston, pp. 233–242.

    Google Scholar 

  • Oxley, J., Roberts, M., Dana-Haeri, J., and Trimble, M. (1981). Evaluation of prolonged 4–channel EEG-taped recordings and serum prolactin levels in the diagnosis of epileptic and nonepileptic seizures. In Dam, M., Gram, L., and Penry, J. K. (eds.), Advances in Epileptology: XIIth Epilepsy International Symposium, Raven Press, New York, pp. 343–354.

    Google Scholar 

  • Pakalnis, A., Drake, M. E., and Phillips, B. (1991). Neuropsychiatric aspects of psychogenic status epilepticus. Neurology 41: 1104–1106.

    Google Scholar 

  • Peguero, E., Abou-Khalil, B., Fakhoury, T., and Matthews, G. (1994). Self-injury and incontinence in psychogenic seizures. Epilepsia 36: 586–591.

    Google Scholar 

  • Physician's Desk Reference.Available at http://www.healthandage.com/ html/res/pdr.

  • Podreka, I., Lang, W., Suess, E., Wimberger, D., Steiner, M., Gradner, W., Zeitlhofer, J., Pelzl, G., Mamoli, B., and Deecke, L. (1988). Hexa-methyl-propylene-amine-oxime (HMPAO) single photon emission computed tomography (SPECT) in epilepsy. Brain Topography 1: 55–60.

    Google Scholar 

  • Potolicchio, S. J., Kay, G. G., and Miles, R. (1989). Minnesota Multiphasic Personality Inventory (MMPI) profiles in patients with psychogenic seizures. Neurology 39(Suppl. 1): 149–150.

    Google Scholar 

  • Price, H. E., Rosenbaum, D. H., Rowan, A. J., and Snyder, S. L. (1992). Measurement of regional cerebral blood flow by SPECT in nonepileptic seizure disorder patients. Epilepsia 33(Suppl. 3): 54.

    Google Scholar 

  • Pritchard, P. B., Wannamaker, B. B., Sagel, J., and Daniel, C. M. (1985). Serum prolactin and cortisol levels in evaluation of pseudoepileptic seizures. Annals of Neurology 18: 87–89.

    Google Scholar 

  • Ramani, V. (2000). Treatment of the adult patient with non-epileptic seizures. In Gates, J. R., and Rowan, A. J. (eds.), Non-epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 311–316.

    Google Scholar 

  • Ramani, V., and Gumnit, R. J. (1982). Intensive monitoring of interictal psychosis in epilepsy. Annals of Neurology 11: 613–622.

    Google Scholar 

  • Ramchandani, D., and Schindler, B. A. (1993). Distinguishing features of pseudocomplex partial seizures. Bulletin of the Menninger Clinic 56: 479–486.

    Google Scholar 

  • Rao, M. L., Stefan, H., and Bauer, J. (1989). Epileptic but not psychogenic seizures are accompanied by simultaneous elevation of serum pituitary hormones and cortisol levels. Neuroendocrinology 49: 33–39.

    Google Scholar 

  • Rechlin, T., Lowe, T. H., and Joraschky, P. (1997). Pseudoseizure “status”. Journal of Psychosomatic Research 42: 495–498.

    Google Scholar 

  • Reeves, A. L., McAuley, J. W., Moore, J. L., and Capestany, J. (1998). Medication use, self-reported drug allergies, and estimated medication cost in patients with epileptic versus nonepileptic seizures. Journal of Epilepsy 11: 191–194.

    Google Scholar 

  • Reuber, M., Enright, S. M., and Goulding, P. J. (2000). Postoperative pseudostatus. Anaesthesia 55: 70–78.

    Google Scholar 

  • Risse, G. L., Mason, S. L., and Mercer, D. K. (2000). Neuropsychological performance and cognitive complaints in epileptic and nonepileptic seizure patients. In Gates, J. R., and Rowan, A. J. (eds.), Non-epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp. 139–150.

    Google Scholar 

  • Rodrigues, M., Botelho, M. M., Fonseca, A. T., Peter, J. P., Pimentel, T., and Vieira, M. R. (1996). Combined study of 99mTc-HMPAO SPECT and computerized electroencephalographic topography (CET) in patients with medically refractory complex partial epilepsy. Annals of Nuclear Medicine 10: 113–118.

    Google Scholar 

  • Rosenberg, H. J., Rosenberg, S. D., Williamson, P. D., and Wolford, G. L. (2000). A comparative study of trauma and posttraumatic stress disorder prevalence in epilepsy patients and psychogenic nonepileptic seizure patients. Epilepsia 41: 447–452.

    Google Scholar 

  • Rosenbaum, M. (2000). Psychogenic seizures-Why women? Psychosomatics 41: 147–149.

    Google Scholar 

  • Roy, A. (1989). Pseudoseizures: Psychiatric perspective. Journal of Neuropsychiatry 1: 69–71.

    Google Scholar 

  • Sackellares, J. C., Giordani, B., Berent, S., Seidenberg, F. E., Dreifuss, F. E., Vanderzant, C. W., and Boll, T. J. (1985). Patients with pseudoseizures: Intellectual and cognitive performance. Neurology 35: 116–119.

    Google Scholar 

  • Sagyi, S., Katz, A., Marks, D. A., and Spencer, S. S. (1992). Frontal lobe partial seizures and psychogenic seizures: Comparison of clinical and ictal characteristics. Neurology 42: 1274–1277.

    Google Scholar 

  • Salloway, S., and White, J. (1997). Paroxysmal limbic disorder in neuropsychiatry. The Journal of Neuropsychiatry and Clinical Neurosciences 9: 403–419.

    Google Scholar 

  • Savard, G., and Andermann, F. (1990). Convulsive pseudoseizures: A review of current concepts. Behavioural Neurology 3: 133–141.

    Google Scholar 

  • Schachter, S. C., Brown, F., and Rowan, A. J. (1996). Provocative testing for nonepileptic seizures: Attitudes and practices in the United States among American Epilepsy Society members. Journal of Epilepsy 9: 249–252.

    Google Scholar 

  • Schlaug, G., and Patel, M. (1997). Radiographic assessment of patients with epilepsy. In Schachter, S. C., and Schomer, D. L. (eds.), The Comprehensive Evaluation and Treatment of Epilepsy: A Practical Guide, Academic Press, New York, pp. 37–59.

    Google Scholar 

  • Schramke, C., Valeriano, J., and Kelly, K. (Feb. 2001). Predicting pseudoseizures using routine EEG, the MMPI, and years of seizures: A replication. Poster session presented at the annual meeting of the International Neuropsychological Society, Chicago, IL.

  • Silva, W., Giagante, B., Saizar, R., D'Alessio, L., Oddo, S., Consalvo, D., Saidon, P., and Kochen, S. (2001). Clinical features and prognosis of nonepileptic seizures in a developing country. Epilepsia 42: 398–401.

    Google Scholar 

  • Singh, U. K., and Jana, U. K. (1994). Plasma prolactin in epilepsy and pseudoseizures. Indian Pediatrics 31: 667–669.

    Google Scholar 

  • Shaw, D. J. (1966). Differential MMPI performance in pseudo-seizure, epileptic and pseudo-neurologic groups. Journal of Clinical Psychology 22: 271–275.

    Google Scholar 

  • Shaw, D. J., and Matthews, C. G. (1965). Differential MMPI performance of brain-damaged vs. pseudo-neurologic groups. Journal of Clinical Psychology 21: 405–408.

    Google Scholar 

  • Shen, W., Bowman, E. S., and Markand, O. N. (1990a). Presenting the diagnosis of pseudoeseizure. Neurology 40: 756–759.

    Google Scholar 

  • Shen, W., Bowman, E. S., and Markand, O. N. (1990b). Pseudoeseizures. Neurology 40: 1478–1479.

    Google Scholar 

  • Slater, J. D., Brown, M. C., Jacobs, W., and Ramsay, R. E. (1995). Induction of pseudoseizures with intravenous saline placebo. Epilepsia 36: 580–585.

    Google Scholar 

  • Smith, C. A., Saykin, A. J., Riordan, H. J., Flashman, L. A., and Williamson, P. D. (1997a). Neuropsychological differentiation of psychogenic versus frontal lobe epilepsy. The Journal of Neuropsychiatry and Clinical Neurosciences 9(1): 169.

    Google Scholar 

  • Smith, M. L., Stagno, S. J., Dolske, M., Kosalko, J., McConnell, C., Kaspar, L., and Lederman, R. (1997b). Induction procedures for psychogenic seizures: Ethical and clinical consideration. The Journal of Clinical Ethics 8: 217–229.

    Google Scholar 

  • Spanaki, M. V., Spencer, S. S., Corsi, M., MacMullan, J., Seibyl, J., and Zubal, I. G. (1999). The role of quantitative ictal SPECT analysis in the evaluation of nonepileptic seizures. Journal of Neuroimaging 9: 210–216.

    Google Scholar 

  • Stagno, S. J., and Smith, M. L. (1996). Use of induction procedures in diagnosing psychogenic seizures. Journal of Epilepsy 9: 153–158.

    Google Scholar 

  • Stagno, S. J., and Smith, M. L. (1997). The use of placebo in diagnosing psychogenic seizures: Who is being deceived? Seminars in Neurology 17: 213–218.

    Google Scholar 

  • Steinberg, J. L., Devous, M. D., and Paulman, R. G. (1996). Wisconsin card sorting activated regional cerebral blood flow in first break and chronic schizophrenic patients and normal controls. Schizophrenia Research 19: 177–187.

    Google Scholar 

  • Stewart, R. S., Lovitt, R., and Stewart, R. M. (1982). Are hysterical seizures more than hysteria? A research diagnostic criteria, DSM-III, and psychometric analysis. American Journal of Psychiatry 139: 926–929.

    Google Scholar 

  • Storzbach, D., Binder, L. M., Salinsky, M. C., Campbell, B. R., and Mueller, R. M. (2000). Improved prediction of nonepileptic seizures with combined MMPI and EEG measures. Epilepsia 41: 332–337.

    Google Scholar 

  • Swanson, S. J., Springer, J. A., Benbadis, S. R., and Morris, G. L. (2000). Cognitive and psychological functioning in patients with non-epileptic seizures. In Gates, J. R., and Rowan, A. J. (Eds.), Non-Epileptic Seizures, 2nd edn., Butterworth-Heinemann, Boston, pp.123–137.

    Google Scholar 

  • Szaflarski, J. P., Ficker, D. M., Cahill, W. T., and Privitera, M. D. (2000). Four-year incidence of psychogenic nonepileptic seizures in adults in Hamilton County, OH. Neurology 55: 1561–1563.

    Google Scholar 

  • Tatum, W. O., Chheda, H., and Easton, T. S. (1993). SPECT during suggestion of nonepileptic seizures. Epilepsia 34(Suppl. 6): 61.

    Google Scholar 

  • Thacker, K., Devinsky, O., Perrine, K., Alper, K., and Luciano, D. (1993). Nonepileptic seizures during apparent sleep. Annals of Neurology 33: 414–418.

    Google Scholar 

  • Thompson, P. M., Batzel, L. W., and Wilkus, R. J. (1992). Millon clinical multiaxial inventory assessment of patients manifesting either psychogenic or epileptic seizures. Journal of Epilepsy 5: 226–230.

    Google Scholar 

  • Tojek, T. M., Lumley, M., Barkley, G., Mahr, G., and Thomas, A. (2000). Stress and other psychosocial characteristics of patients with psychogenic nonepileptic seizures. Psychosomatics 41: 221–226.

    Google Scholar 

  • Trimble, M. R. (1978). Serum prolactin in epilepsy and hysteria. BMJ 16: 1682.

    Google Scholar 

  • Trimble, M. R., Dana-Haeri, J., Oxley, J., and Baylis, P. H. (1984). Some neuroendocrine consequences of seizures. In Porter, R. J. (ed.), Advances in Epileptology: XVth Epilepsy International Symposium, Raven Press, New York, pp. 201–208.

    Google Scholar 

  • Trimble, M. R., Ring, H. A., and Schmitz, B. (1996). Neuropsychiatric aspects of epilepsy. In Fogel, B. S., Schiffer, R. B., and Rao, S. M. (eds.), Neuropsychiatry, Williams and Wilkins, Baltimore, MD, pp. 771–803.

    Google Scholar 

  • Vanderzant, C. W., Giordani, B., Berent, S., Dreifuss, F. E., and Sackellares, J. C. (1986). Personality of patients with pseudoseizures. Neurology 36: 664–668.

    Google Scholar 

  • Varma, A. R., Moriarty, J., Costa, D. C., Gacinovic, S., Schmitz, E. B., Ell, P. J., and Trimble, M. R. (1996). HMPAO SPECT in non-epileptic seizures: Preliminary results. Acta Neurologica Scandinavica 94: 88–92.

    Google Scholar 

  • Walczak, T. S., Williams, D. T., and Berten,W. (1994). Utility and reliability of placebo infusion in the evaluation of patients with seizures. Neurology 44: 394–399.

    Google Scholar 

  • Warner, M. H., Wilkus, R. J., Vossler, D. G., Wyler, A. R., and Abson-Kraemer, D. L. (1996). MMPI-2 profiles in differential diagnosis of epilepsy vs psychogenic seizures. Epilepsia 37(Suppl. 5): 19.

    Google Scholar 

  • Weil, S., Noachtar, S., Arnold, S., Yousry, T. A., Winkler, P. A., and Tatsch, K. (2001). Ictal ECD-SPECT differentiates between temporal and extratemporal epilepsy: Confirmation by excellent postoperative seizure control. Nuclear Medicine Communications 22: 233–237.

    Google Scholar 

  • Westbrook, L. E., Devinsky, O., and Geocadin, R. (1998). Nonepileptic seizures after head injury. Epilepsia 39: 978–982.

    Google Scholar 

  • Wheless, J. W., Galan, A., Barron, B. J., Tran, H. D., Willmore, J., Curtis, V. L., and Lamki, L. M. (1993). Nonepileptic seizures: Diagnostic verification with ictal and interictal SPECT. Epilepsia 34(Suppl. 2): 140.

    Google Scholar 

  • Wilkus, R. J., and Dodrill, C. B. (1989). Factors affecting the outcome of MMPI and neuropsychological assessments of psychogenic and epileptic seizure patients. Epilepsia 30: 339–347.

    Google Scholar 

  • Wilkus, R. J., Dodrill, C. B., and Thompson, P. M. (1984). Intensive EEG monitoring and psychological studies of patients with pseudoepileptic seizures. Epilepsia 25: 100–107.

    Google Scholar 

  • Wilkus, R. J., Thompson, P. M., and Vossler, D. G. (1990). Bizarre ictal automatisms: Frontal lobe epileptic or psychogenic seizures? Journal of Epilepsy 3: 207–213.

    Google Scholar 

  • Willmore, L. J., Wheless, J. W., Curtis, V. L., Barron, B. J., Tran, H. D., and Fletcher, J. M. (1992). SPECT abnormalities in patients with nonepileptic seizures. Epilepsia 33(Suppl. 3): 53–54.

    Google Scholar 

  • Wood, B. L., McDaniel, S., Burchfiel, K., and Erba, G. (1998). Factors distinguishing families of patients with psychogenic seizures from families of patients with epilepsy. Epilepsia 39: 432–437.

    Google Scholar 

  • Wyllie, E., Luders, H., MacMillan, J. P., and Gupta, M. (1984). Serum prolactin levels after epileptic seizures. Neurology 34: 1601–1604.

    Google Scholar 

  • Zaidi, A., Crampton, S., Clough, P., Fitzpatrick, A., and Scheepers, B. (1999). Head-up tilting is a useful provocative test for psychogenic non-epileptic seizures. Seizure 8: 353–355.

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, University of Kentucky Medical Center, Lexington, Kentucky

    Dona E. Cragar & David T. R. Berry

  2. Department of Neurology, University of Kentucky Medical Center, Lexington, Kentucky

    Toufic A. Fakhoury & Jean E. Cibula

  3. Mount Carmel Medical Center, Columbus, Ohio

    Jean E. Cibula

  4. Departments of Neurology, Psychiatry, Psychology, and Behavioral Science, University of Kentucky Medical Center, Lexington, Kentucky

    Frederick A. Schmitt

  5. Sanders-Brown Center on Aging, University of Kentucky Medical Center, Lexington, Kentucky

    Frederick A. Schmitt

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Cragar, D.E., Berry, D.T.R., Fakhoury, T.A. et al. A Review of Diagnostic Techniques in the Differential Diagnosis of Epileptic and Nonepileptic Seizures. Neuropsychol Rev 12, 31–64 (2002). https://doi.org/10.1023/A:1015491123070

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