Diagnosis Of Epileptic Seizures Research Articles

Diagnosis of epilepsy – consequences for work and professional activities

Summary Introduction. The correct diagnosis of epileptic seizures and non-epileptic attacks has a decisive influence on treatment, counseling and duration of possible work limitations. Diagnostic efforts should aim towards classifying the seizure as precisely as possible. For risk assessments, e.g. at the workplace, a close cooperation and networking of all professionals involved in the epilepsy treatment, care and consultation processes is required. Aim. To present guidelines for assessment of occupational capacity of persons with epilepsy and to discuss their value in clinical practice. Method and Material. The German employer’s liability insurance association has recently published the new revised BGI 585 Risk Assessment Guidelines (DGUV information 250-001) framework and assistance in epilepsy in view of protection against unfair dismissal. These guidelines provide information on safety and health in the workplace. Throughout all the German federal states, 24 Network teams were established. During the period January 2010 and December 2013, 374 employees with epilepsy were consulted by an expert member of Network Epilepsy and Work (NEA) Team, of which 80 were prospectively included in a study and scientifically evaluated. Guidelines and discussion. While conducting the risk assessment, a special medical fact check in accordance with the guidelines was used. In addition to medical aspects, the individual vocational and occupational situation was considered. Based on this assessment an individual recommendation was made relating to continuation of employment. The project NEA established regional teams of physicians, therapists, consultants from social services, employment offices and rehabilitation authorities across Germany in order to link by networks the complex medical and social aspects of reducing the risk of people with epilepsy losing their job. Results. It was shown that support and consultation through the NEA team led to an endangered position of employment being maintained in 70% of cases. Conclusion. In many cases, loss of employment can be prevented by consequent application of DGUV information 250-001 (recently revised from BGI 585) for risk assessment of epilepsy in employment, together with improved networking between medical professionals, occupational health professionals and social services.

Misdiagnosis of gastroesophageal reflux disease as epileptic seizures in children

BackgroundGastroesophageal reflux disease (GERD) can mimic epileptic seizure, and may be misdiagnosed as epilepsy. On the other hand, GERD can be more commonly seen in children with neurological disorders such as cerebral palsy (CP); this co-incidence may complicate the management of patients by mimicking refractory seizures. ObjectiveThe purpose of our study was to evaluate the clinical features, definite diagnoses and treatment approaches of the patients with clinically suspected GERD who were referred to the division of pediatric neurology with a suspected diagnosis of epileptic seizure. We also aimed to investigate the occurrence of GERD in children with epilepsy and/or CP. MethodsFifty-seven children who had a final diagnosis of GERD but were initially suspected of having epileptic seizures were assessed prospectively. ResultsAll patients were assigned to 3 groups according to definite diagnoses as follows: patients with only GERD who were misdiagnosed as having epileptic seizure (group 1: n=16; 28.1%), those with comorbidity of epilepsy and GERD (group 2: n=21; 36.8%), and those with the coexistence of GERD with epilepsy and CP (group 3: n=20; 35.1%). Five patients (8.8%) did not respond to anti-reflux treatment and laparoscopic reflux surgery was performed. The positive effect of GERD therapy on paroxysmal nonepileptic events was observed in 51/57 (89.5%) patients. ConclusionsGERD is one of the important causes of paroxysmal nonepileptic events. In addition, GERD must be kept in mind at the initial diagnosis and also in the long-term management of patients with neurological disorders such as epilepsy and CP.

Mind the gap: Multiple events and lengthy delays before presentation with a "first seizure".

Up to half of patients assessed for suspected new-onset epileptic seizures report previous undiagnosed events. This suggests that delay to timely and expert assessment is a major issue. Very little is known about the degree of delay or nature of the undiagnosed events, impacting on our understanding of new-onset epilepsy. In this study we aimed to examine events that occur before presentation, as well as the extent and risk factors for delay to assessment. Included in this retrospective study were 220 patients diagnosed at the First Seizure Clinic (Austin Health, Australia) between 2003 and 2006 with an epileptic index seizure. Patients with a prior diagnosis of epileptic seizures were excluded. Chartreview was undertaken, including detailed interviews conducted by an epileptologist at first assessment. Logistic regression assessed risk factors for delay from first event to presentation, including event characteristics, socioeconomic disadvantage, employment, and distance to medical facility. Forty-one percent (n=90) of patients had one or more event before their index seizure. Of these, 50% had multiple or more than five prior events and 28% experienced one or more convulsive event before the index seizure. Of the total 220 patients, 36% had delayed presentation >4weeks, 21% delayed >6months, and 14% delayed >2years. First events without convulsions or features likely to disrupt behaviour were strongly associated with delay (p=<0.001). Relative socioeconomic disadvantage was also associated with delay to presentation (p=0.04). Our findings suggest a gap in early diagnosis and care in a sizable proportion of new-onset cases, despite a "first world" urban environment and the availability of free basic medical care. Delay appears particularly likely when events are nonconvulsive or low-impact, suggesting that these seizure types may be underrepresented in studies of new-onset epilepsy. This has implications for our understanding of the incidence, evolution, impact, and treatment response of new-onset epilepsy.

A neural network based infant monitoring system to facilitate diagnosis of epileptic seizures.

In this paper, we propose an infant monitoring system that automatically detects epileptic seizures in domestic and hospital environments. The proposed system measures the movements and electroencephalogram (EEG) signals of an infant using a video camera and an electroencephalograph. Seizure features are then extracted from the video images and EEG signals, and the evaluation indices based on medical knowledge are calculated from the features. The system employs a probabilistic neural network for the automatic detection of seizures, thereby allowing the choice/combination of evaluation indices appropriate for the environment via network training. We tested the system in simulated domestic and hospital environments. The validity of the proposed system was reinforced by the results of comparisons with clinical diagnoses.

Loss of Autonoetic Awareness of Recent Autobiographical Episodes and Accelerated Long-Term Forgetting in a Patient with Previously Unrecognized Glutamic Acid Decarboxylase Antibody Related Limbic Encephalitis.

We describe a 35-year-old male patient presenting with depressed mood and emotional instability, who complained about severe anterograde and retrograde memory deficits characterized by accelerated long-term forgetting and loss of autonoetic awareness regarding autobiographical memories of the last 3 years. Months before he had experienced two breakdowns of unknown etiology giving rise to the differential diagnosis of epileptic seizures after various practitioners and clinics had suggested different etiologies such as a psychosomatic condition, burnout, depression, or dissociative amnesia. Neuropsychological assessment indicated selectively impaired figural memory performance. Extended diagnostics confirmed accelerated forgetting of previously learned and retrievable verbal material. Structural imaging showed bilateral swelling and signal alterations of temporomesial structures (left >right). Video-EEG monitoring revealed a left temporal epileptic focus and subclincal seizure, but no overt seizures. Antibody tests in serum and liquor were positive for glutamic acid decarboxylase antibodies. These findings led to the diagnosis of glutamic acid decarboxylase antibody related limbic encephalitis. Monthly steroid pulses over 6 months led to recovery of subjective memory and to intermediate improvement but subsequent worsening of objective memory performance. During the course of treatment, the patient reported de novo paroxysmal non-responsive states. Thus, antiepileptic treatment was started and the patient finally became seizure free. At the last visit, vocational reintegration was successfully in progress. In conclusion, amygdala swelling, retrograde biographic memory impairment, accelerated long-term forgetting, and emotional instability may serve as indicators of limbic encephalitis, even in the absence of overt epileptic seizures. The monitoring of such patients calls for a standardized and concerted multilevel diagnostic approach with repeated assessments.

Analysis of Minnesota Multiphasic Personality Inventory-2-Restructured Form response bias indicators as suppressors or moderators in a medical setting.

The use of response bias indicators in psychological measurement has been contentious, with debate as to whether they actually suppress or moderate the ability of substantive psychological indicators to identify the construct of interest. Suppression would indicate that predictor variables contain invalid variance that the bias indicators can suppress, while moderation would indicate differential levels of predictive validity at different levels of bias. Response bias indicators on the Minnesota Multiphasic Personality Inventory (MMPI)-2-Restructured Form (MMPI-2-RF) [infrequent responses (F-r), infrequent somatic responses (Fs), infrequent psychopathology responses (Fp-r), adjustment validity (K-r), uncommon virtues (L-r), symptom validity (FBS-r), and Response Bias Scale (RBS)] were tested to determine whether they suppressed or moderated the ability of the Restructured Clinical Scale 1 (RC1) and Neurologic Complaints (NUC) scale to discriminate between epileptic seizures (ES) and nonepileptic seizures (NES, a conversion disorder that is often misdiagnosed as ES). The MMPI-2-RF was completed by 399 patients with a confirmed diagnosis of ES or NES via Epilepsy Monitoring Unit evaluation. Moderated logistic regression was used to test for moderation, and logistic regression was used to test for suppression. Most of the response bias variables showed a suppressor effect, but moderator effects were not found. These findings extend the use of bias indicators to a psychomedical context.

Traumatic Brain Injury and Psychogenic Seizures in Veterans

To evaluate a proposed seizure etiology of traumatic brain injury (TBI) as a risk factor for psychogenic nonepileptic seizures (PNESs), the effect of reported TBI severity on the diagnosis of PNES versus epileptic seizures (ESs), and the potential moderating role of posttraumatic stress disorder (PTSD). Veterans with a diagnosis of PNES or ES during epilepsy monitoring at a Veterans Affairs Medical Center. Retrospective review of seizure type, proposed seizure etiology, TBI severity, and PTSD. Both PNES and ES groups were compared for TBI history and severity, and prior diagnosis of PTSD. Traumatic brain injury was the proposed seizure etiology for 57% of 67 PNES patients versus 35% of 54 ES patients (P < .05). It was mild in 87% of PNES patients and 37% of ES patients (P < .001). Posttraumatic stress disorder increased the likelihood of diagnosing PNES versus ES in Veterans with mild TBI as the proposed seizure etiology. Veterans with PNES commonly cite a TBI as the cause for seizures. Mild TBI was strongly associated with PNES versus ES. Posttraumatic stress disorder may moderate the development of PNES in Veterans with a history of mild TBI. Clinicians caring for Veterans with seizures may use these results in selecting patients for early diagnostic evaluation.

Analyzing reliability of seizure diagnosis based on semiology

This study aimed to determine the accuracy of seizure diagnosis by semiological analysis and to assess the factors that affect diagnostic reliability. A total of 150 video clips of seizures from 50 patients (each with three seizures of the same type) were observed by eight epileptologists, 12 neurologists, and 20 physicians (internists). The videos included 37 series of epileptic seizures, eight series of physiologic nonepileptic events (PNEEs), and five series of psychogenic nonepileptic seizures (PNESs). After observing each video, the doctors chose the diagnosis of epileptic seizures or nonepileptic events for the patient; if the latter was chosen, they further chose the diagnosis of PNESs or PNEEs. The overall diagnostic accuracy rate for epileptic seizures and nonepileptic events increased from 0.614 to 0.660 after observations of all three seizures (p<0.001). The diagnostic sensitivity and specificity of epileptic seizures were 0.770 and 0.808, respectively, for the epileptologists. These values were significantly higher than those for the neurologists (0.660 and 0.699) and physicians (0.588 and 0.658). A wide range of diagnostic accuracy was found across the various seizures types. An accuracy rate of 0.895 for generalized tonic–clonic seizures was the highest, followed by 0.800 for dialeptic seizures and then 0.760 for automotor seizures. The accuracy rates for myoclonic seizures (0.530), hypermotor seizures (0.481), gelastic/dacrystic seizures (0.438), and PNESs (0.430) were poor. The reliability of semiological diagnosis of seizures is greatly affected by the seizure type as well as the doctor's experience. Although the overall reliability is limited, it can be improved by observing more seizures.

How long is long enough? The utility of prolonged inpatient video EEG monitoring

Video EEG monitoring (VEM) is a valuable tool for the diagnosis of epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES). We sought to determine the benefits of prolonged length of stay (LOS). We retrospectively reviewed the records of patients admitted for VEM. We analyzed LOS for ES and PNES patients to determine if there was reduced utility, as evidenced by a significantly higher inconclusive outcome, beyond a certain duration. We calculated receiver operating characteristic (ROC) curves to determine optimal cut off points for LOS based on futility. Patients admitted with presumed PNES were significantly more likely to have an inconclusive admission (31/150, 20.7%) versus all others (58/446, 13%, p=0.033). There was no significant difference in the likelihood of having an inconclusive admission if monitoring was continued for any duration in patients with ES (area under curve, AUC, 0.46). For patients with PNES, a LOS ≥5 days was associated with an increased risk of the stay being inconclusive (28% versus 12.5%, p=0.026). Although the ROC curve suggested a cut off of 5.5 days, it did not predict outcomes well (AUC 0.52, sensitivity 0.55, specificity 0.5). Based on our data, prolonging VEM appears useful for the proper classification and localization of ES.

Pertinence de la prescription au service d’accueil des urgences d’un électroencéphalogramme après un malaise du nourrisson

Neurological causes are common diagnoses for apparent life-threatening events in infants. The objective of this study was to evaluate the relevancy of electroencephalography performed after an apparent life-threatening event. A retrospective study was conducted in a children's hospital over a 1-year period. The charts of infants under 2 years of age who were admitted following an apparent life-threatening event were reviewed. Clinical and biological data were collected and electroencephalograms - divided into normal and abnormal - were reviewed. To evaluate the follow-up state of the patients, parents were invited to complete an evaluation form an average 13 months after the event. The yield for electroencephalography was established according to the ratio of positive results contributing to the diagnosis of the cause of the apparent life-threatening event. A total of 47 patients met the inclusion criteria. Fifteen had had an EEG, 32 had not. The rate of abnormal neurological signs described by parents during the apparent life-threatening event was higher in the EEG group compared to the group without EEG (53% vs. 22%, P=0.05). In the follow-up, 35% of the children presented a second event, which was described as being similar or less impressive and occurred in the 1st month after the event (91%). Of the eight abnormal electroencephalograms, six had no specific abnormalities and two contributed to the diagnosis of epileptic seizure. Therefore, the diagnostic yield of electroencephalography in this study was 13% (2/8). The yield of electroencephalography performed after an apparent life-threatening event is low. Neurological history and repeated physical examinations still remain the major diagnostic tools before resorting to electroencephalography.

Postictal serum creatine kinase for the differential diagnosis of epileptic seizures and psychogenic non-epileptic seizures: a systematic review.

The aim of this review was to evaluate the sensitivity and specificity of postictal creatine kinase (CK) levels in the differential diagnosis of epileptic seizures (ES) and psychogenic non-epileptic seizures (PNES). A systematic search was conducted for studies that evaluated postictal CK levels in patients with ES (all types) and PNES. Sensitivity and specificity with 95% confidence intervals were determined for each study, taking into account: (a) the upper limits adopted; and (b) the 95.7th percentile values, which are recently proposed practical upper reference limits for CK activity. Four studies, comprising a total of 343 events (248 ES and 95 PNES), were available for analysis. Most patients (47/78, 60%) with ES considered had primarily or secondarily generalized tonic-clonic seizures. The sensitivity of increased postictal CK levels for ES ranged from 14.6 to 87.5, whereas specificity ranged from 85.0 to 100.0. At the 95.7th percentile threshold, sensitivity ranged from 14.6 to 62.5 and specificity was 100.0. The limited number of studies available, their small sample size, and lack of individual event data prevented further stratification analysis by seizure type. Despite the clinical heterogeneity and the limitations of the included studies, increased postictal CK levels are highly specific for the diagnosis of ES, although no definite conclusion on its role in differentiating between convulsive and non-convulsive ES can be drawn. Postictal serum CK levels can provide valuable retrospective information at the later stages of the differential diagnosis of ES and PNES. Due to low sensitivity, normal postictal CK levels do not exclude ES.

Out-of-body experiences associated with seizures

Alterations of consciousness are critical factors in the diagnosis of epileptic seizures. With these alterations in consciousness, some persons report sensations of separating from the physical body, experiences that may in rare cases resemble spontaneous out-of-body experiences. This study was designed to identify and characterize these out-of-body-like subjective experiences associated with seizure activity. Fifty-five percent of the patients in this study recalled some subjective experience in association with their seizures. Among our sample of 100 patients, 7 reported out-of-body experiences associated with their seizures. We found no differentiating traits that were associated with patients' reports of out-of-body experiences, in terms of either demographics; medical history, including age of onset and duration of seizure disorder, and seizure frequency; seizure characteristics, including localization, lateralization, etiology, and type of seizure, and epilepsy syndrome; or ability to recall any subjective experiences associated with their seizures. Reporting out-of-body experiences in association with seizures did not affect epilepsy-related quality of life. It should be noted that even in those patients who report out-of-body experiences, such sensations are extremely rare events that do not occur routinely with their seizures. Most patients who reported out-of-body experiences described one or two experiences that occurred an indeterminate number of years ago, which precludes the possibility of associating the experience with the particular characteristics of that one seizure or with medications taken or other conditions at the time.

Stimulus-induced myoclonus treated effectively with clonazepam in genetically confirmed Coffin-Lowry syndrome.

PurposeCoffin–Lowry syndrome (CLS) is a rare X-linked semidominant syndromic genetic disorder that is characterized by typical facial and radiologic findings, psychomotor and growth retardation, and various skeletal anomalies. A distinctive paroxysmal disorder called stimulus-bound myoclonus is clinically heterogeneous and is generally characterized by a sudden loss of muscle tone that is regained within a few seconds and is induced by sudden auditory or tactile stimulus. As the pathophysiology of stimulus-induced drop episodes (SIDEs) is not well understood, there is no definite therapy for those episodes.MethodsWe report a 15-year-old female with stimulus-induced drop episodes occurring many times a day that resulted in failure to perform her daily activities. Because her SIDEs were misdiagnosed as atonic seizures, she was treated with several antiepileptic drugs, including valproic acid, levetiracetam, lamotrigine, primidone, carbamazepine, and clobazam.ResultsWe realized that her clinical and radiological findings, together with SIDEs, are compatible with Coffin–Lowry syndrome. All of her medications were discontinued following the diagnosis of SIDE, and she was started on clonazepam. After treatment, she became more independent and was able to perform her daily activities. Subsequently, her episodes decreased from 3 times a day to 1–2 times a month. Sodium oxybate and fluoxetine were added to the treatment protocol without remarkable improvement. Her genetic analysis revealed a heterozygous variation of CLS.ConclusionWe conclude that SIDE should be included in a differential diagnosis of epileptic seizures in patients with CLS and that clonazepam is an effective choice in the treatment of SIDEs.

EEG Under Sleep-Deprived Conditions: Its Usefulness in Psychiatry: Two Case Examples

Epilepsy is a brain disorder characterized by recurrent and unpredictable seizures. It is associated with an increased risk of developing mental disorders. Electroencephalography (EEG) is the most important diagnostic tool for this disease; however, a normal EEG cannot exclude the diagnosis of epileptic seizures, so EEG performed under sleep deprivation was performed in two case examples treated in the psychiatry clinic, in order to prove that sleep deprivation may increase epileptiform discharges.

EEG newborn 60 min vs. 30 min

Introduction Electroencephalography (EEG) has been widely used in the neonatal intensive care units (NICU) for assessment and monitoring of brain function in preterm and term babies. The most common indications are the diagnosis of epileptic seizures or other kinds of events, assessment of brain maturity, and recovery/prognosis from hypoxic-ischemic events. EEG recording techniques have dramatically improved, but there is still a lot to understand and to do. The aim of this poster is to determine the occurrence of quiet sleep in the NICU during 1 h EEG recording. To determine the occurrence of quiet sleep in EEG in the NICU as well as the factors which influence its appearance and recognition the need of 1 h instead of half hour recording EEG. Materials and methods A prospective review was conducted of all newborn patients who were admitted or transferred to the NICU from February 2013 to April 2013 (35 patients) with an unexplained decrease in level of consciousness or no overt clinical seizures. Results Thirty out of 35 patients who met the criteria for inclusion in the study were found to have quiet sleep. A part of the group (16/35) had quiet sleep in the first half hour. Most of them (14/16) without touching or nurse assistance during the recording. The largest group of patients (18/35) did not have quiet sleep in the first half hour due to electrode problems, nurse assistance or ambient/surrounding disturbances. And 5/35 did not fall asleep in the recording. In this last group, (13/18), had quiet sleep in the half hour left, when the ambiental problems stopped it. A small group of patients (5/18) had many arousals due to intrinsic reasons, such as neurological or metabolic conditions. In the smallest sample group (1/35) we were not able to tell the difference between the awake state and the quiet sleep due to prematurity of the brain/severe encephalopathy. In the remainder, the variability of do not have quiet sleep in the first 30 min included: Tech’s manipulation (39%), nurses (28%), epilepsy-related seizure (5%), and others (22%). Conclusion Quiet sleep is an environment and process related. Almost half of the patients were not having quiet sleep due to extrinsic factors. This report highlights the importance of paying close attention to the tech and the timing of the recording in order to guarantee that we have quiet sleep in the NICU patients. Acknowledgement To Sick Kids Hospital and Hospital Universitario La Fe.

An update on non-epileptic seizures: Diagnosis and brief notes on treatment

Abstract Non-epileptic seizures (NES) are episodes that appear as epileptic seizures, but are not caused by epileptic discharges in the brain. The inclusion of NES in the differential diagnosis of epileptic seizures is important, as an accurate diagnosis is required for the administration of appropriate treatment. NES in the differential diagnosis may be classified as (1) physiologic or pathophysiologic NES, e.g. syncope, sleep disturbances, motor symptoms, migraine attacks, etc., and (2) psychogenic NES (PNES), e.g. affective disorders with anxiety or panic, dissociative disorders (somatoform or conversion) as well as depression or posttraumatic stress disorder (PTSD). PNES is the condition most frequently misdiagnosed as epilepsy. We report NES as experienced in our epilepsy monitoring unit (EMU) for adults in the neurology department of a university hospital in Norway. Our main emphasis is on PNES, highlighting the diagnostic procedures, currently recommended treatment options, and follow-up. A team approach with video-EEG monitoring and clinical observation by trained nurses, epileptologists and other personnel is preferred in the diagnosis and treatment of PNES. Evaluations are performed by a neuropsychologist and trained social worker. The EMU closely cooperates with cardiologists and sleep center specialists. They can also refer patients to psychosomatic medicine specialists. Components of the differential diagnosis addressed are syncope, motor symptoms, sleep disorders, migraine and other paroxysmal neurological symptoms.

The startle syndromes: Physiology and treatment

SummaryStartle syndromes are paroxysmal and show stimulus sensitivity, placing them in the differential diagnosis of epileptic seizures. Startle syndromes form a heterogeneous group of disorders with three categories: hyperekplexia (HPX), stimulus‐induced disorders, and neuropsychiatric syndromes. HPX is characterized by an exaggerated motor startle reflex combined with stiffness and is caused by mutations in different parts of the inhibitory glycine receptor, leading to brainstem pathology. The preserved consciousness distinguishes it from epileptic seizures. Clonazepam is the first‐choice therapy. The stimulus‐induced disorders cover a broad range of epileptic and nonepileptic disorders, and distinguishing the two can be difficult. Additional information from electroencephalography (EEG) and video registration can help. Many stimulus‐induced disorders now have an identified gene defect. Antiepileptic drugs, including benzodiazepines, are frequently mentioned as the best treatment option. Neuropsychiatric syndromes are on the borderland of neurology and psychiatry, and their etiology is poorly understood. These syndromes include startle‐induced tics, culture‐specific disorders such as Latah, and functional startle syndromes. The electromyography (EMG) startle reflex in these syndromes is characterized by variable recruitment patterns and the presence of a second “orienting” response. Treatment options are limited, but urgently required. In the clinical setting, the patient’s history and a (home) video recording together with genetic and electrophysiologic testing help to classify these challenging disorders.

Conversation analysis in the differential diagnosis of Italian patients with epileptic or psychogenic non-epileptic seizures: A blind prospective study

The differential diagnosis of epileptic seizures (ES) and psychogenic non-epileptic seizures (PNES) is often difficult. The diagnostic gold standard is video-EEG, but this procedure is limited because of its high cost and is not always available. Research groups from Germany and Britain have used conversation analysis (CA) of patients' descriptions of their seizures as a means of differentiating the type of seizure. The aim of this study was to verify the value of their considerations in relation to the Italian language. Ten subjects (five with ES and five with PNES) diagnosed by means of the video-EEG recording of one seizure were studied under blind conditions by a linguist. The patients with ES described their seizures in as much detail as possible and tried to reconstruct the experience as fully as they can, making an effort to describe their subjective symptoms, quantify the duration of the phases preceding and following the seizure, and use the image of an external entity overcoming them. On the contrary, the patients with PNES repeated their extraneousness to the events that occur, refused to reply, expressed amnesia, reconstructed the happening by referring to descriptions provided by witnesses, and often describe their seizures using the image of an internal entity of which they were victims. The linguist correctly identified nine cases out of ten using CA.

Psychiatric comorbidity in veterans with psychogenic seizures

Psychogenic non-epileptic seizures (PNES) are frequently encountered in epilepsy monitoring units (EMU) at Veterans Affairs Medical Centers (VAMCs) and cause significant long-term disability. An understanding of psychiatric factors associated with PNES could aid in earlier diagnosis and treatment. We studied 50 consecutive veterans diagnosed with PNES and 37 veterans diagnosed with epileptic seizures (ES), evaluated at a VAMC EMU. We reviewed all available mental health evaluations prior to EMU evaluation. Univariate comparisons included axis I diagnoses, axis II diagnoses, and psychiatric hospitalizations. Predictive models of seizure classification were evaluated by logistic regression. A diagnosis of post-traumatic stress disorder (PTSD) preceded the diagnosis of PNES in 58% of patients and the diagnosis of ES in 13.5% (p<0.001). On logistic regression, PTSD was the only significant psychiatric diagnosis (odds ratio 9.2). Major depression and alcohol abuse were common diagnoses but did not differentiate PNES and ES groups.

Epileptic Encephalopathies in Adults and Childhood

Epileptic encephalopathies are motor-mental retardations or cognitive disorders secondary to epileptic seizures or epileptiform activities. Encephalopaties due to brain damage, medications, or systemic diseases are generally not in the scope of this definition, but they may rarely accompany the condition. Appropriate differential diagnosis of epileptic seizures as well as subclinical electroencephalographic discharges are crucial for management of seizures and epileptiform discharges and relative regression of cognitive deterioration in long-term followup. Proper antiepileptic drug, hormonal treatment, or i.v. immunoglobulin choice play major role in prognosis. In this paper, we evaluated the current treatment approaches by reviewing clinical electrophysiological characteristics of epileptic encephalopathies.