Epileptic seizures and pseudoseizures from the viewpoint of the hierarchy of consciousness

Treating Pseudoseizures and Related Behaviors in an Adult Male with an Intractable Seizure Disorder

AD, a 42-year-old male diagnosed with an intractable seizure disorder, profound mental retardation, and numerous medical diagnoses, manifested pseudoseizures and related behaviors. To reduce the frequency of these behaviors, treatment procedures were developed and implemented. In conjunction with direct care staff members, target behaviors were identified and defined: pseudoseizures, falling, and sliding from chair. The behavioral treatment applied combined antecedent control and a progressive intervention approach using verbal cueing, visually checking, tactile attention, and edible reinforcement. Data collection occurred over an 18-month period. Results show an increase in the number of days occurring without charted behaviors within consecutive 28-day reporting periods. Data collection consisted of 7,068 observations of AD's behaviors. This allowed correlations to be conducted with significant correlations existing between pseudoseizures and falling ( r = .59) and chair sliding and positive observations ( r = —.63). t tests were computed resulting in significant differences between AD's target behaviors and pseudoseizures.

Intelligence functions disorders in patients with complex partial epilepsy

OBJECTIVES: To compare the performance of patients with complex partial epilepsy with the normal controls in the subtests of an instrument used to assess intelligence function. METHOD: Fifty epileptic patients, whose ages ranged from 19 to 49 years and 20 normal controls without any neuropsychiatric disorders. The Wechsler-Bellevue adult intelligence test was applied in groups, epileptic patients and control subjects. This test is composed of several subtests that assess specific cognitive functions. A statistical analysis was performed using non-parametric tests. RESULTS: All the Wechsler-Bellevue subtests revealed that the intelligence functions of the patients were significantly inferior to that of the controls (p<0.05). This performance was supported by the patient's complaints in relation to their cognitive performance. CONCLUSION: Patients with complex partial epilepsy presented poorer results in the intelligence test when compared with individuals without neuropsychiatric disorders.

Special considerations in treating bipolar disorder in women

There are obvious gaps in research surrounding issues specific to women who suffer from bipolar disorder, including gender differences and their implications for management, the impact of the reproductive cycle, and evidence based treatment guidelines for pregnancy and the postpartum period. Gender differences have not been reported for the prevalence of bipolar disorder; however, women are more likely to experience rapid cycling, mixed mania, and antidepressant-induced manias. This may affect response to treatment, which has been found, in some cases, to differ in men and women. In addition, side effects in response to treatments may well differ in men and women, especially with regard to lithium and valproate prescription. The course of bipolar disorder in women may be influenced by the menstrual cycle, pregnancy, the postpartum period, and menopause, although many issues require further clarification. Treatment of bipolar disorder during pregnancy and the postmenopausal period requires careful consideration, as does treatment during the childbearing years, as some mood stabilizers influence the metabolism of oral contraceptives. This review article has attempted to evaluate existing literature regarding women with bipolar disorder in a comprehensive and critical way, and to consolidate into a single source the gender-specific aspects of the disorder that may have treatment implications for women.

Postoperative pseudoepileptic seizures in a known epileptic: complications in recovery

A 47-yr-old woman underwent general anaesthesia for a squint correction. She had previously suffered a cerebral venous thrombosis, presenting as grand mal seizures during recovery from general anaesthesia for minor surgery. Subsequently, she was affected by Jacksonian limb seizures and petit mal epilepsy and had required long-term rehabilitation, and anticonvulsant and anticoagulant therapy. On arrival in recovery on this occasion, with a laryngeal mask airway (LMA) in place, she started to convulse. The seizures were initially treated with midazolam i.v., but they recurred. Whilst observing the seizure pattern and excluding the differential diagnoses, evidence emerged that psychological factors had played a large part in her clinical picture. Her differential diagnosis had recently been amended to include 'pseudoseizures'. A firm, supportive approach caused the 'convulsions' to cease within a few hours.

Semiologia e características clínicas das crises pseudo-epilépticas

Os autores discutem as características semiológicas e clínicas de crises não-epilépticas psicogênicas e o papel de elementos de natureza inconsciente na gênese desses fenômenos. Essas crises constituem condição psicopatológica relativamente freqüente em centros de atendimento de pacientes portadores de epilepsia e em serviços de emergência psiquiátrica. O diagnóstico diferencial entre ambos os quadros nem sempre representa tarefa fácil e exige do clínico conhecimento das manifestações semiológicas tanto de crises genuinamente epilépticas, como de crises conversivas, de natureza essencialmente psicogênica.

Involvement of the thalamocortical system in epileptic loss of consciousness

Experiments on putative neuronal mechanisms underlying absence seizures as well as clinical observations are critically reviewed for their ability to explain apparent "loss of consciousness." It is argued that the initial defect in absences lies with corticothalamic (CT) neuronal mechanisms responsible for selective attention and/or planning for action, rather than with those establishing either the states or the contents of consciousness. Normally, rich thalamocortical (TC)-CT feedback loops regulate the flow of information to the cortex and help its neurons to organize themselves in discrete assemblies, which through high-frequency (>30 Hz) oscillations bind those distributed processes of the brain that are considered important, so that we are able to focus on what is needed from moment to moment and be aware of this fact. This ability is transiently lost in absence seizures, because large numbers of CT loops are recruited for seconds in much stronger, low-frequency ( approximately 3 Hz) oscillations of EPSP/IPSP sequences, which underlie electroencephalographic (EEG) spike-and-wave discharges (SWDs). These oscillations probably result from a transformation of the normal EEG rhythm of sleep spindles on an abnormal increase of cortical excitability that results in strong activation of inhibitory neurons in the cortex and in nucleus reticularis thalami. The strong general enhancement of CT feedback during SWDs may disallow the discrete feedback, which normally selects specific TC circuits for conscious perception and/or motor reaction. Such a mechanism of SWD generation allows variability in the extent to which different TC sectors are engaged in the SWD activity and thus explains the variable ability of some patients to respond during an absence, depending on the sensory modality examined.