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Dissociative and Epileptic seizures: how to distinguish them?

INTRODUCTION: Dissociative seizures (DS) are classified as dissociative convulsions within the group of dissociative disorders. Although they share many features with epileptic seizures (ES), they are not a consequence of abnormal brain discharges and may be related to psychogenic causes. DS represe...

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Autores principales: Certo, A., Rodrigues, J., Nombora, O., Basto, M., Mendes, E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9567827/
http://dx.doi.org/10.1192/j.eurpsy.2022.1222
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author Certo, A.
Rodrigues, J.
Nombora, O.
Basto, M.
Mendes, E.
author_facet Certo, A.
Rodrigues, J.
Nombora, O.
Basto, M.
Mendes, E.
author_sort Certo, A.
collection PubMed
description INTRODUCTION: Dissociative seizures (DS) are classified as dissociative convulsions within the group of dissociative disorders. Although they share many features with epileptic seizures (ES), they are not a consequence of abnormal brain discharges and may be related to psychogenic causes. DS represent a common diagnostic and are often confounded with ES. OBJECTIVES: The aim of this study is to review the current evidence about the differential diagnosis between DS and ES. METHODS: We conducted a non-sytematic review on the topic, using Pubmed/Medline database. RESULTS: Studies emphasize a correct diagnosis before treatment of seizures. DS and ES respond differently to anticonvulsant medication and early or incorrect prescription of can even exacerbate DS. Clinical features and a neuropsychiatric history can also help. The presence of a dissociative “stigmata”, such as unexplained sensory loss, may support a non-epileptic diagnosis. EEG videorecording method is the gold standard diagnosis for DS, however often displays rhythmic movement artifacts that may resemble seizure activity and confound the interpretation. The absence of ictal EEG discharges characteristic of epilepsy is a sign of DS. However, this may not be true for some partial ES, particularly those from temporal lobes, whom also tend to report shorter duration of seizures, whereas patients with DPD often describe experiences lasting for hours or longer. CONCLUSIONS: Distinguish DS from ES can be challenging. However, there are features that can help in the differential diagnosis. A correct diagnosis is essential for an adequate therapeutic approach, better prognosis, reduction of medical costs and also a referral to the right medical specialty. DISCLOSURE: No significant relationships.
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spelling pubmed-95678272022-10-17 Dissociative and Epileptic seizures: how to distinguish them? Certo, A. Rodrigues, J. Nombora, O. Basto, M. Mendes, E. Eur Psychiatry Abstract INTRODUCTION: Dissociative seizures (DS) are classified as dissociative convulsions within the group of dissociative disorders. Although they share many features with epileptic seizures (ES), they are not a consequence of abnormal brain discharges and may be related to psychogenic causes. DS represent a common diagnostic and are often confounded with ES. OBJECTIVES: The aim of this study is to review the current evidence about the differential diagnosis between DS and ES. METHODS: We conducted a non-sytematic review on the topic, using Pubmed/Medline database. RESULTS: Studies emphasize a correct diagnosis before treatment of seizures. DS and ES respond differently to anticonvulsant medication and early or incorrect prescription of can even exacerbate DS. Clinical features and a neuropsychiatric history can also help. The presence of a dissociative “stigmata”, such as unexplained sensory loss, may support a non-epileptic diagnosis. EEG videorecording method is the gold standard diagnosis for DS, however often displays rhythmic movement artifacts that may resemble seizure activity and confound the interpretation. The absence of ictal EEG discharges characteristic of epilepsy is a sign of DS. However, this may not be true for some partial ES, particularly those from temporal lobes, whom also tend to report shorter duration of seizures, whereas patients with DPD often describe experiences lasting for hours or longer. CONCLUSIONS: Distinguish DS from ES can be challenging. However, there are features that can help in the differential diagnosis. A correct diagnosis is essential for an adequate therapeutic approach, better prognosis, reduction of medical costs and also a referral to the right medical specialty. DISCLOSURE: No significant relationships. Cambridge University Press 2022-09-01 /pmc/articles/PMC9567827/ http://dx.doi.org/10.1192/j.eurpsy.2022.1222 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Certo, A.
Rodrigues, J.
Nombora, O.
Basto, M.
Mendes, E.
Dissociative and Epileptic seizures: how to distinguish them?
title Dissociative and Epileptic seizures: how to distinguish them?
title_full Dissociative and Epileptic seizures: how to distinguish them?
title_fullStr Dissociative and Epileptic seizures: how to distinguish them?
title_full_unstemmed Dissociative and Epileptic seizures: how to distinguish them?
title_short Dissociative and Epileptic seizures: how to distinguish them?
title_sort dissociative and epileptic seizures: how to distinguish them?
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9567827/
http://dx.doi.org/10.1192/j.eurpsy.2022.1222
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