Abstracts

Hysteroid epilepsy (Gowers), psychogenic seizures (ancient Egyptians and Greeks), pseudo seizures, and non-epileptic seizures are but a few of the terms used to describe epileptiform attacks without an abnormal, excessive electrical discharge (Jackson) from the brain. Today, NEEDS represent a group of physiologic and psychologic conditions that mimic epilepsy, and constitute 10 to 20% of children and up to 40% of adults admitted to epilepsy monitoring units. Advances in diagnosis and management of epilepsy in the last quarter century, have made the diagnosis easier, but have not dispelled the myths remaining in the literature regarding the clinical profile of this condition. Our objective is to study the demographic profile and analyze the clinical features of the psychogenic variety of NEEDS by video EEG characteristics in a comprehensive epilepsy program setting.
1) Medical records of patients who underwent video/EEG monitoring at the Comprehensive Oklahoma Program for Epilepsy for a six year period from the beginning in March 1995 to February 2000, were reviewed for, demographic data, medical and psychiatric history and co-morbid conditions. 2) The video/EEGs for the same period were reviewed to characterize the clinical features of the recorded events during monitoring. 3) The seizure type, stereotypy, and time to record the first event were tabulated. Associated features such as pelvic thrusting, crying, body position at onset were scrutinized.
Of 844 patients monitored, 178 (21.1%) patients had NEEDS without a physiologic basis. The male (48) to female (130) ratio was 1:3.7. The age range was 35.9 [plusmn] 12 years and duration of the disorder was 9.1 [plusmn] 12.2 years. 141 (79.2%) were receiving 1-4 AEDs, although only 9 (5%) had documented epileptic seizures. Psychiatric history was present in 58 (32.6%) and family history of seizures in 35 (19.6%). 103 (57.2%) had their first seizure within 24 hours of admission (Mean + SD = 24.8 [plusmn] 24.6 hours). The most common clinical manifestation was generalized motor activity in 144 (80.1%), and the least common (4%) was loss of tone (atonic seizure). Other features included tremors (34.3%), partial motor activity (28.7%), sensory symptoms (25.8%), and staring and unresponsiveness (25.3%). Stereotypy was noted in 114 (64%), pelvic thrusting occurred in 38 (21.3%), associated crying in 20 (11.2%) and seizures started while in the prone position in 12 (6.7%) of patients. Interictal EEG abnormalities were noted in 45 (25.3%).
1) Psychogenic NEEDS occur more commonly in women (M:F ratio of 1:3.7). 2) Generalized motor activity is the most (80.1%) and loss of tone (4%) the least common clinical presentation. 3) The vast majority (79.2%) were receiving one to four medications for an average of 9 years at a high cost to the patient. 4) Video/EEG monitoring yielded the diagnosis within 2 days of admission in most patients and can help patients save the cost of medications and avoid their long term toxic side effects.