PREICTAL BEHAVIOR IN PSYCHOGENIC AND EPILEPTIC SEIZURES

The purpose of our research was to study isolated manifestations obser ved before the attack proper in psychogenic seizures (PS). We studied preictal behavior in 192 PS in 97 consecutive patients diagnosed with prolonged electroencephalogram (EEG)-closed circuit TV (CCTV) monitori ng. For comparison, we reviewed 81 complex partial seizures (CPS) reco rded in 22 patients. We defined the onset of attacks based on patient or family report, or as the beginning of altered responsiveness or pro minent motor activity or collapse. We studied the 5 minutes preceding perceived seizure onset as well as the seizure proper. Unusual movemen ts or minor behavioral alterations were seen preceding the attack prop er in 130 PS (68%) but only seven CPS (9%). In PS, the movements were repetitive in nature in 77% and discontinuous in 94%. They usually sto pped before the onset of the attack proper. The predominant movements were most often in the upper extremities (25%), in the head or face (2 0%), or migratory (22%). Preictal behavioral changes are common in PS and may be helpful in differentiating PS from epileptic seizures. (C) 1998 by Elsevier Science Inc. All rights reserved.