EPILEPTIC SEIZURES PROGRESSING INTO NONEPILEPTIC CONVERSION SEIZURES

Background: Epileptic and nonepileptic seizures can occur in the same patient, but usually occur at different times. In 1885, Gowers suggest ed that minor seizures can elaborate into hysterical seizures, but the concurrence of epileptic and nonepileptic seizures is not well docume nted. Methods: We reviewed all patients with nonepileptic seizures doc umented with video-EEG recordings at our center to identify those with temporally associated epileptic seizures. Results: Four patients were identified in whom video-EEG-documented epileptic seizures were tempo rally associated with nonepileptic seizures. In one woman, the nonepil eptic event followed an absence seizure. Given the high frequency of a bsence seizures, the occurrence of the nonepileptic seizure may have b een coincidental. In three patients, the seizures were partial and aro se fi om right frontotemporal regions. In these patients, epileptic se izures were frequent. Conclusions: Epileptic and nonepileptic seizures can be temporally related, and in patients with partial seizures, the re may be a pathophysiologic relation in which ictal changes facilitat e the development of conversion symptoms. Ictal activation or disinhib ition of emotions or impulse control may contribute to these nonepilep tic events.