Neuropsychiatric Symptoms of Epilepsy

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M. Schmutz
and motor signs they have formed—among other motor and sensory phenomena—
the core symptoms of old hysteria since the ancient Egyptians and Greeks until the
beginning of the twentieth century [ 1 ].
Displaying semiological features with oftentimes striking similarity to epileptic
and other somatogenic seizures, dissociative seizures require profound medical and
neurological expertise in order to achieve diagnostic certainty. Therefore, neurological
examination to exclude epileptic seizures or other somatogenic paroxysms
ranks first in the medical assessment, while psychiatric and psychotherapeutic interventions
follow secondary. This succession of neurological and psychiatric involvement
corresponds to the illness behavior of most patients with dissociative seizures,
who actively seek neurological advice first and only reluctantly (if at all) accept
referral to a mental health specialist. Most probably, this subordinate status is a
major reason for the rather poor scientific contribution of contemporary psychiatry,
compared to the abundant neurological literature in the field. To fill the psychiatric
void, neurological contributions pertain—nolens volens—far beyond their differential
diagnostic expertise and cover genuine psychiatric issues like etiology, treatment,
outcome, and prognosis of dissociative seizures.
This chapter covers the topic of dissociative seizures in adolescent and adult
patients. Dissociative seizures also occur in younger patients. Many of the following
issues may apply to children with dissociative seizures as well. For specific
information, however, the specialized pediatric literature is authoritative.
Definition
Dissociative seizures are defined as paroxysmal events with alterations of consciousness,
emotions, motor body control, and/or sensory functions. They are psychogenic,
i.e., internal and/or external stress and the psychological mechanisms of
dissociation and conversion play a crucial role in their etiopathogenesis. In regard to
semiology they tend to mimic epileptic seizures, however, electroencephalography
during dissociative seizures does not show epileptiform activity. From a nosological
point of view, dissociative seizures represent an accompanying symptom of an
underlying psychiatric disorder.
Terminology
To begin with, some remarks related to naming and terminology may be helpful.
Dissociative seizures are often circumscribed by a number of different terms in current
scientific literature: non-epileptic attack disorder, pseudo-seizures, psychogenic
non-epileptic seizures, non-epileptic seizures of non-organic origin, and
functional seizures—just to mention a few [ 2 – 7 ]. In the last decades, most research
papers on dissociative seizures have been written by neurologists and published in