SEATTLE—Clinical manifestations of psychogenic nonepileptic seizures are similar in women and men, with the exception of longer duration of seizures and more recurrent spells in women, according to results of a study presented at the 62nd Annual Meeting of the American Epilepsy Society.
Ifeanyi Iwuchukwu, MD, and colleagues reviewed records of all patients admitted to the epilepsy monitoring unit at the JFK Medical Center in Edison, New Jersey, from 2003 to 2007. A total of 32 females and 10 males older than 18 with nonepileptic seizures were included in the analysis. “There were more females than males, because nonepileptic seizures are more common in women,” noted Dr. Iwuchukwu, a fourth-year neurology resident at the New Jersey Neuroscience Institute in Edison.
With the use of video EEG monitoring, the researchers found that clinical manifestations were generally similar between the two genders. Seizures occurred daily and weekly in 60% of men and 50% of women. All of the men had seizures within 24 hours of hospitalization, compared with 75% of the women. Bilateral motor manifestations occurred in 75% of women and 70% of men, and pelvic thrusting occurred in 17% of women and 10% of men.
Several differences were observed between women and men, said the researchers. Six women (19%) had seizures lasting longer than 20 minutes, compared with none of the men. In addition, 25% of the women had recurrent seizures for more than two days after admission, compared with none of the men after 24 hours.
Dr. Iwuchukwu explained his center’s approach to treating patients with nonepileptic seizures. “For proper treatment, it is important to make the distinction between epilepsy and nonepileptic seizures,” he said. “After we diagnose psychogenic nonepileptic seizures, we apply a multidisciplinary treatment. Historically, a confrontational approach is not effective, and we don’t just send them out without antiepileptic drugs. We involve a psychiatrist and psychologist.
“The idea is to try and provide the patients with behavioral techniques that will allow them to control the events and avoid injury and hospitalizations. Hospitalizations for nonepileptic seizures can be particularly dangerous, because the patients may mistakenly be treated for status epilepticus, resulting in intubation, ventilation, and use of high doses of benzodiazepines.”
Dr. Iwuchukwu concluded that when informing patients of the diagnosis, it is important to try to avoid the term “psychogenic seizures,” which many patients may hesitate to share with family and other health care professionals.
—Andrew N. Wilner, MD