Share This Article:

Epilepsy versus non-epileptic attack disorder: A diagnostic and therapeutic challenge

Full-Text HTML XML Download Download as PDF (Size:46KB) PP. 1-4
DOI: 10.4236/crcm.2013.21001    5,831 Downloads   8,524 Views  


Epilepsy and non-epileptic attack disorder (NEAD) share a vast number of clinical features, however the aetiology and management are very different. Video-EEG is the gold standard diagnostic tool and relies on the occurrence of seizure activity during assessment to make a diagnosis. Added complexity arises from the co-existence of epilepsy and NEAD, occurring in a significant proportion of patients. Comprehensive assessment and investigation is therefore required to prevent gross mistreatment in this diagnostically difficult subgroup. We present a case of NEAD with co-existing epilepsy and the challenges that this may present in clinical practice.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Smith, C. and Ramtahal, J. (2013) Epilepsy versus non-epileptic attack disorder: A diagnostic and therapeutic challenge. Case Reports in Clinical Medicine, 2, 1-4. doi: 10.4236/crcm.2013.21001.


[1] Dorland, W. (2003)Dorland’s illustrated medical dictionary. Saunders, Philadelphia.
[2] Smith, D., Defalla, B.A. and Chadwick, D.W. (1999) The misdiagnosis of epilepsy and the management of refrac- tory epilepsy in a specialist clinic. Quarterly Journal of Medicine, 92, 15-23. doi:10.1093/qjmed/92.1.15
[3] Benbadis, S.R. and Allen, H.W. (2000) An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure, 9, 280-281. doi:10.1053/seiz.2000.0409
[4] Jones, S.G., O’Brien, T.J., Adams, S.J., et al. (2010) Clinical characteristics and outcome in patients with psychogenic nonepileptic seizures. Psychosomatic Medicine, 72, 487-497. doi:10.1097/PSY.0b013e3181d96550
[5] LaFrance Jr., W.C. and Devinsky, O. (2004) Treatment of nonepileptic seizures: Historical perspectives and future directions. Epilepsia, 45, 15-21. doi:10.1111/j.0013-9580.2004.452002.x
[6] Reuber, M., Jamnadas-Khoda, J., Broadhurst, M., et al. (2011) Psychogenic nonepileptic seizure manifestations reported by patients and witnesses. Epilepsia, 52, 2028- 2035. doi:10.1111/j.1528-1167.2011.03162.x
[7] Rowan, A.J. (2000) Diagnosis of non-epileptic seizures. In: Gates, J.R., Rowan, A.J., Eds., Non-Epileptic Seizures, 2nd Edition, Butterworth-Heinemann, Boston, 15-30.
[8] Lesser, R.P. (1986) Psychogenic seizures. Psychosomatics, 27, 823-829. doi:10.1016/S0033-3182(86)72587-5
[9] Marchetti, R.L., Kurcgant, D., Gallucci-Neto, J., Von Bismark, M.A. and Fiore, L.A. (2010) Epilepsy in patients with psychogenic non-epileptic seizures. Arquivos de Neuro-Psiquiatria, 68, 168-173. doi:10.1590/S0004-282X2010000200003
[10] Hauser, W.A. and Beghi, E. (2008) First seizure definitions and worldwide incidence and mortality. Epilepsia, 49, 8-12. doi:10.1111/j.1528-1167.2008.01443.x
[11] Alsaadi, T.M. and Marquez, A.V. (2005) Psychogenic nonepileptic seizures. American Family Physician, 72, 849-856.
[12] Glauser, T., Ben-Menachem, E., Bourgeois, B., et al. (2006) ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia, 47, 1094-1120. doi:10.1111/j.1528-1167.2006.00585.x
[13] Twamley, E.W. and Bortz, J.J. (1999) Nonepileptic seizures: Neuropsychological mechanisms. BNI Quarterly, 15, 20-26.
[14] Ghougassian, D.F., d’Souza, W., Cook, M.J. and O’Brien, T.J. (2004) Evaluating the utility of inpatient video-EEG monitoring. Epilepsia, 45, 928-932. doi:10.1111/j.0013-9580.2004.51003.x
[15] Szaflarski, J.P., Hughes, C., Szaflarski, M., et al. (2003) Quality of life in psychogenic nonepileptic seizures. Epi lepsia, 44, 236-242. doi:10.1046/j.1528-1157.2003.35302.x
[16] Vincentiis, S., Valente, K.D., Thomé-Souza, S., Kuczinsky, E., Fiorea, L.A. and Negr?oa, N. (2006) Risk factors for psychogenic nonepileptic seizures in children and adolescents with epilepsy. Epilepsy & Behavior, 8, 294- 298. doi:10.1016/j.yebeh.2005.08.014
[17] World Health Organization. The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines.
[18] Epilepsy Society (2012) Table of anti-epileptic drugs used in adults.
[19] Kenneb?ck, G., Ericson, M., Tomson, T. and Bergfeldt, L. (1997) Changes in arrhythmia profile and heart rate variability during abrupt withdrawal of antiepileptic drugs. Implications for sudden death. Seizure, 6, 369-375. doi:10.1016/S1059-1311(97)80036-2
[20] Mellers, J.D.C. (2004) The approach to patients with “non-epileptic seizures”. Postgraduate Medical Journal, 13, 146-155.
[21] Reuber, M., Fernández, G., Bauer, J., Helmstaedter, C. and Elger, C.E. (2004) Diagnostic delay in psychogenic nonepileptic seizures. Neurology, 58, 493-495. doi:10.1212/WNL.58.3.493
[22] Lempert, T. and Schmidt, D. (1990) Natural history and outcome of psychogenic seizures: A clinical study in 50 patients. Journal of Neurology, 237, 35-38. doi:10.1007/BF00319665
[23] 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. doi:10.1212/WNL.53.5.933

comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.