PRESCRIPTION DRUGS MAY INDUCE PSYCHOGENIC NON-EPILEPTIC SEIZURES
Abstract number :
2.359
Submission category :
Year :
2003
Submission ID :
3698
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
David R. Bruce, J. Christine Dean Social Work-Psychology, Epilepsy Institute of North Carolina, Winston-Salem, NC
One year ago we presented 102 patients with Psychogenic Non-Epileptic Seizures(PNES), Epileptic Seizures(ES), or both, referred to the Comprehensive Epilepsy Program at Epilepsy Institute of NC (EINC) between the years 2001 and 2002. We studied these patients with interviews, diagnostic tests,Personality Assessment Inventory (PAI) subscales for Conversion Reaction, and Video-EEG with induction. 77% of the Epileptic Seizures(ES) showed Depression, and 100% of the Psychogenic Non-Epileptic Seizures(PNES) showed Somatization (subscales of PAI).
We now report an unusual source of PNES patients from clinical settings that have no premorbid psychiatric histories,but are inducible by Alcohol Patch Induction.
58 patients were referred to EINC with events that occurred in medical offices, patient clinics, or in operating rooms,and in the Instensive Care Unit during IV therapies. Their PNES were short-term: six weeks to three months (10 weeks), remitting with minimum therapy, some spontaneously. All patients were adults in [quot]white collar[quot] jobs, had no previous psychiatric history,or premorbid history of physical, emotional, sexual abuse, depression, or brain lesions. All had contact with prescription drugs administered orally or parenterally. All patients recieved three or more IV medications.
Routine diagnostic tests, MRIs, EEGs, Labs, Video-EEGs with induction were performed, followed by PAI and Cognitive Batteries. 53 patients were inducible, four were suggestible, and one non-inducible.
PAI subscales for Conversion Reaction, Anxiety, Depression, Atypical Thinking and Individual Psychological Interviews showed no overt psychopathology. Cognitive testing demonstrated normal executive functions in this group.
These findings suggest that drugs plus environmental factors, such as manipulative procedures, may impact on emotions and should be examined as critical determinants in the formation of PNES in a given individual. Diagnosis by Video-EEG induction should be supported with Conversion Reaction subscales testing for valid diagnosis in patients that are referred for seizure disorders.