NONEPILEPTIC POSTTRAUMATIC SEIZURES

Purpose: Epileptic posttraumatic seizures (PTSs) are a well-recognized consequence of head injury (HI), but HI and nonepileptic seizures (NE Ss) have not been related. We describe a significant subset of patient s with NESs who had their seizures attributed to HI. Methods: We revie wed the records of all patients diagnosed with NES at the University o f Maryland Medical Center over a B-year period (1989-1995) and selecte d patients with seizures attributed to a head injury occurring less th an or equal to 3 years before the onset of their seizures. Results: Of 157 patients with video-EEG confirmed NES, 37 (24%) had the onset of their seizures attributed to an HI. Their average age was 34 years (ra nge, 15-56 years); 68% were women. Nonepileptic PTS usually developed within the first year after HI (89%). Convulsive symptoms were present in 54%. Whereas epileptic PTSs characteristically follow severe HI, t he majority (78%) of our patients with nonepileptic PTSs sustained onl y mild HI. Before their HI, 76% of our patients were employed, working in the home, or students, but only 11% could continue those activitie s after developing nonepileptic PTSs. Conclusions: Nonepileptic PTSs a re frequently mistaken for epileptic PTSs and result in serious disabi lity. The misdiagnosis of nonepileptic PTSs leads to ineffective and i nappropriate treatment. Patients with intractable seizures after HIs, particularly mild HIs, should be carefully evaluated for NESs.