NONEPILEPTIC SEIZURES AFTER HEAD-INJURY

Purpose: To examine the role of head injury as a risk factor in the de velopment of nonepileptic seizures (NES). Specifically, we will determ ine the relative frequency of head injury among NES patients referred to our center and will describe several pertinent clinical features an d personal characteristics. Methods: Retrospective record review of pa tients referred to our center for evaluation of seizures over a 4-year period. All patients with NES were evaluated as in a previously descr ibed protocol, which included intensive video EEG monitoring, provocat ion by suggestion, and psychiatric interview. All NES patients with a history of head injury were extracted for this report. Results: Of 102 patients with NES, nearly one-third (32%) had an antecedent head inju ry; 52% were male, mean age was 34 years, and 12% had coexisting epile psy. Multiple psychiatric disorders were not uncommon (79%), and a his tory of abuse was found in 35%. All but four patients had documented f inancial gain from their injury. Follow-up at 1 year found poor long-t erm outcome with lasting disability; despite that, the majority (91%) of head injuries were minor. Conclusions: Our preliminary findings sug gest that prior head injury is associated with the development of NES and may contribute to the pathogenesis of NES in vulnerable patients. Head injury and sexual or physical abuse appear to occur in comparable proportions in patients with NES. This suggests that head injury and abuse may be equally important risk factors in the development of NES.