De Novo Dissociative Seizures after Cranial Neurosurgery.
Abstract number :
2.113
Submission category :
Year :
2001
Submission ID :
613
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
M. Reuber, MD, Department of Epileptology, University of Bonn, Bonn, Germany; J. Schramm, MD, Department of Neurosurgery, University of Bonn, Bonn, Germany; C.C. Elger, MD, Epileptology, University of Bonn, Bonn, Germany
RATIONALE: The de novo manifestation of dissociative seizures is well recognized after epilepsy surgery but not cranial neurosurgery for other indications. We present 15 patients with postoperative dissociative attacks in whom neurosurgery was not undertaken to control refractory epileptic seizures.
METHODS: All patients (10 women, mean age at presentation 39.0 years) attended our department with refractory persistent seizures following neurosurgery. The surgical lesions had presented with epileptic seizures (8 patients), headache (2), depression (2), diplopia (1), hearing (1) and memory loss (1). The patients had undergone complete or partial removal of a meningioma (5), AV angioma (3), cavernoma (1), papilloma (1), neurinoma (1), astrocytoma (1), oligodendroglioma (1), dysontogenetic cyst (1) or subdural hematoma (1). The diagnosis of dissociative seizures was based on ictal video-EEG (4), EEG (6), observation and examination (7), or suggestive injection of 0.9% NaCl (10). Additional epileptic seizures were confirmed by ictal EEG/video EEG in 2 patients, otherwise the diagnosis was based on the clinical assessment of an experienced epileptologist.
RESULTS: Six patients had purely dissociative postoperative seizure disorders, 9 had epileptic and non-epileptic attacks. The mean age at neurosurgery was, 32.5 years (range 5-54), the mean latency between surgery and onset of dissociative seizures was 3.6 years (range 0-17 years), the mean delay between onset and diagnosis of non-epileptic attacks was 2.9 years (range 0-19 years).
CONCLUSIONS: A diagnosis of dissociative seizures should be considered in patients who develop seizures after cranial neurosurgery.
Support: St James[ssquote]s Trust for Nervous Diseases, Trustees of the Leeds General Infirmary