Psychogenic, nonepileptic seizures associated with video-EEG-verified sleep.
OBJECTIVE
Nonepileptic seizures (NES) are expressions of a psychiatric disease state, usually conversion disorder, that mimic epileptic seizures (ES) but are not associated with the neurophysiologic changes of epilepsy. Conversion has not been demonstrated to emerge from the sleeping state. Emergence out of sleep is usually considered a virtual exclusion criterion for NES, signifying the presence instead of ES. We sought to test this hypothesis.


METHODS
We retrospectively reviewed the video-EEG of all patients admitted to our epilepsy unit over a 3-year period, who were suspected of manifesting NES. We examined the relation between NES and the patients' sleep/wake state in this cohort. Two epileptologists blindly reviewed an intermixture of cases suspected to represent NES emerging out of sleep, together with control cases. Classification of each case was made independently.


RESULTS
We found that in a small minority of patients (<1%), NES began either while the patient was sleeping, or within several seconds of arousal, well before a plan to simulate a seizure could likely have been formulated in the wakeful state.


CONCLUSIONS
In some cases, NES are not the product of the awake mind, but rather represent a psychiatric condition that can be manifest in sleep.
Orbach
Darren
D
Department of Neurology and Comprehensive Epilepsy Center, NYU Medical Center, New York, New York 10016, USA.
Ritaccio
Anthony
A
Devinsky
Orrin
O
D000328:Adult; D000513:Alpha Rhythm; D001143:Arousal / Q000502:physiology; D015331:Cohort Studies; D003291:Conversion Disorder / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000503:physiopathology; D014741:Video Recording