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 suggested that minor seizures can elaborate into hysterical seizures, but the concurrence of epileptic and nonepileptic seizures is not well documented.


METHODS
We reviewed all patients with nonepileptic seizures documented 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 temporally associated with nonepileptic seizures. In one woman, the nonepileptic event followed an absence seizure. Given the high frequency of absence seizures, the occurrence of the nonepileptic seizure may have been coincidental. In three patients, the seizures were partial and arose from right frontotemporal regions. In these patients, epileptic seizures were infrequent.


CONCLUSIONS
Epileptic and nonepileptic seizures can be temporally related, and in patients with partial seizures, there may be a pathophysiologic relation in which ictal changes facilitate the development of conversion symptoms. Ictal activation or disinhibition of emotions or impulse control may contribute to these nonepileptic events.
Devinsky
O
O
Department of Neurology, New York University Medical Center, New York, USA.
Gordon
E
E
D000328:Adult; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D002648:Child; D018450:Disease Progression; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications / Q000503:physiopathology*; D004832:Epilepsy, Absence / Q000503:physiopathology; D005260:Female; D005910:Glioma / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000150:complications / Q000503:physiopathology*; D014741:Video Recording