Abstracts

A majority of studies has shown a concurrence rate of epilepsy in patients with nonepileptic seizures (NES) of about 10% to 18%; most frequently epileptic seizures (ES) and NES occur sequentially rather than simultaneously, often beginning with the former (1). This group of patients has found little attention. We have explored the alternating relationship of the two types of paroxysmal disorders and report a novel treatment for patients with the history of both ES and NES - reduction of the antiepileptic drugs (AEDs) to the minimum required to achieve optimal freedom from seizures - that proved remarkably effective in our first two patients, one with initial ES and one with initial NES. The same treatment has since been applied in five more patients with both well documented ES and NES. Presence of ES and NES were documented by Video-EEG (VEEG) whenever possible. AEDs were very gradually decreased as frequent NES predominated. The first patient had experienced nocturnal ES for 30 years. After 2 years of freedom from seizures, diurnal spells occurred and, over 15 years, became more frequent upon increasing antiepileptic treatments; she became anergic, fearful and headaches became constant. After EEG monitoring showed NES only, her antiepileptic treatment was gradually decreased until she regained, after 2 years, full health without seizures.
The second patient was initially diagnosed by VEEG as having NES; he was disabled, anxious and depressed. After 6 years he experienced a flurry of ES, followed by remarkable improvement of his mental state. Upon treatment with AED his former NES condition resumed. He finally recovered once the AED was reduced.
Over the last 6 months, the effectiveness of reducing AEDs has been clearly confirmed in five consecutive patients with both types of seizures. Of the seven patients, five had initially presented for treatment with ES and two with NES. Six had a personal history of early trauma, and five had a family history of epilepsy. A lowering of the AED to the minimum required for control of the ES appears to be required to achieve optimal freedom from either seizure. NESs have a psychobiologic basis and have been recognized as posttraumatic startle seizures (2). Excessive suppression of the epileptic paroxysmal activity favors the expression of the posttraumatic paroxysmal activity in patients with both types of paroxysmal disorders. Of etiological significance is the finding that the patients commonly have both a personal history of trauma and a family history of epilepsy.
1. Krumholz A, Ting T: Coexisting epilepsy and nonepileptic seizures. In: Kaplan PW, Fisher RS, eds: Imitators of Epilepsy, 2^nd ed., New York, Demos, 2005, pp 261-276.
2. Blumer D: On the psychobiology of nonepileptic seizures. In: Gates JR, Rowan AJ, eds: Nonepileptic Seizures. Boston, MA: Butterworth-Heineman, 2000, pp. 305-310.Treatment
Etiology