Clinical features and prognosis of nonepileptic seizures in a developing country

Purpose: To determine the predictive value of clinical features and medical history in patients with nonepileptic seizures (NESs). Methods: One hundred sixty-one consecutive ictal video-EEGs were reviewed, and 17 patients with 41 NESs identified. NES diagnosis was defined as parox ysmal behavioral changes suggestive of epileptic seizures recorded during v ideo-EEG without any electrographic ictal activity. Clinical features, age, sex, coexisting epilepsy, associated psychiatric disorder, social and econ omic factors, delay in reaching the diagnosis of NES, previous treatment, a nd correlation with outcome on follow-up were examined. Results: The study population included 70% female patients with a mean age of 33 years. Mean duration of NESs before diagnosis was 9 years. Forty-one percent had coexisting epilepsy. The most frequent NES clinical features we re tonic-clonic mimicking movements and fear/anxiety/hyperventilation. The most common psychiatric diagnosis was conversion disorder and dependent and borderline personality disorder. Seventy-three percent of patients with pu re NESs received antiepileptic drugs (AEDs), and 63.5% of this group receiv ed new AEDs. Fifty-nine percent of the patients received psychological/psyc hiatric therapy. At follow-up, 23.5% were free of NESs. Conclusions: All seizure-free patients had two good prognostic factors: hav ing an independent lifestyle and the acceptance of the nonepileptic nature of the episodes. Video-EEG monitoring continues to be the diagnostic method to ensure accurate seizure classification. Establishing adequate health ca re programs to facilitate access to new technology in public hospitals as w ell as the implementation of continuous education programs for general prac titioners and neurologists could eventually improve the diagnosis and treat ment of patients with NESs.