ICTAL BEHAVIORS DURING NONEPILEPTIC SEIZURES DIFFER IN PATIENTS WITH TEMPORAL-LOBE INTERICTAL EPILEPTIFORM EEG ACTIVITY AND PATIENTS WITHOUT INTERICTAL EPILEPTIFORM EEG ABNORMALITIES

Purpose: Ictal behaviors during psychogenic nonepileptic seizures (NES ) vary considerably among individuals, and can closely resemble common semiologies of epileptic seizures (ES). We tested the hypothesis that behaviors during NES in patients who have temporal spikes would more closely resemble behaviors during ES in patients with temporal lobe ep ilepsy than would behaviors during NES in patients who do not have EEG spikes. Methods: We identified 20 patients who had interictal tempora l EEG spikes and EEG-video recorded NES (Study Group), 133 patients wi th temporal EEG spikes and recorded ES, without NES (Epileptic Group), and 24 patients with recorded NES and no epileptiform EEG abnormaliti es, without ES (Nonepileptic Group). Results: The hypothesis was suppo rted with regard to ictal motor behaviors. Motionless staring or compl ex automatisms occurred mainly during NES in the Study Group and durin g ES in the Epileptic Group. In contrast, convulsive movements or flac cid falls were most common during NES in the Nonepileptic Group. Durat ion of unresponsiveness was longer, and there were fewer postictal sta tes in NES both in the Study and Nonepileptic Groups. Unresponsiveness was briefer and postictal states were more consistent in ES in the Ep ileptic Group, however.Conclusions: Stereotyped motor activities durin g NES presumably represent learned behaviors. Processes underlying acq uisition of ictal behaviors of NES probably differ in patients with in terictal epileptiform EEG abnormalities compared to those without. Pri or experiences and temporal lobe dysfunctions that ar-associated with epilepsy, and psychological characteristics that are unrelated to inte rictal epileptic dysfunctions, may determine ictal behaviors during NE S.