Abstracts

RATIONALE: Neuroimagaging studies are an integral part of the evaluation in patients with seizures. We examined if patients suspected of having psychogenic seizures were likely to have exclusively normal head CT scan or brain MRI's and compare the rates of abnormalties to patients with epilepsy. METHODS: This was a retrospective study evaluating brain MRI and CT scan results in our patients with proven psyschogenic seizures. All patients had previously undergone inpatient video-EEG monitoring at the Colorado Neurological Institute Epilepsy Center to assure accurate seizure classification. Paients with both epiletic and psychogenic seizures were excluded, as were patients whose official MRI or CT reports were unavailable. RESULTS: Using our database of over 1500 patients, a total of ninety-seven patients with confirmed psychogenic seizures were identified. Eighty-eight had undergone brain MRI and nine patients had only had CT scans. In fourteen patients, imaging reports were unavailable leaving 83 patients in the analysis. Neuroimaging studies were normal 72 pateints (86.7%) and abnormal in 11 (13.3%). Abnormalities included nonspecific white matter changes, cortical atrophy, post stroke or post traumatic encephalomalacia, multiple sclerosis plaques, arachnoid cyst and subdural hygromas. Some of these findings are often seen in patients with epilepsy. In contrast, our patients with epilepsy had abnormal imaging studies 68% of the time. CONCLUSIONS: Abnormal neuroimaging studies are not uncommon in patients with psychogenic seizures. Although the diagnosis of psychogenic seizures is supported by normal imaging studies, video-EEG monitoring remains essential for accurate seizure classification.