PROVOCATION OF NONEPILEPTIC SEIZURES BY SUGGESTION IN A GENERAL SEIZURE POPULATION

Nonepileptic seizures (NES) are common and are often diagnosed at epil epsy centers by video-EEG recording of both spontaneous and suggestion -induced episodes, but no study has evaluated provocative testing in a general seizure population. We studied consecutive patients with a te ntative diagnosis of epilepsy using saline provocation during video-EE G recording, suggesting that this could produce a typical seizure. Of 52 patients, 40% had no response, 23% had responses unlike their seizu res, and 37% had typical episodes (positive test). Patients whose usua l episodes resembled complex partial seizures (CPS) were more likely t o have NES than were patients with a history of generalized tonic-clon ic seizures (GTC). Of patients with positive provocations, the primary physician predicted NES in 68% of cases. This preliminary study sugge sts that NES are frequent in a general neurology setting, and that sal ine provocation is a sensitive method of identifying NES.