title: Nonepileptic attack disorder among married women.
abstract: OBJECTIVE
  To study the clinical features, precipitating stressful life events and prognosis of nonepileptic attack disorder (NEAD) among married women.
  
  
  METHODS
  Prospective cohort study with 1-year follow-up.
  
  
  METHODS
  A tertiary care teaching hospital.
  
  
  METHODS
  Of the 1020 patients with epilepsy referred to the epilepsy clinic during 2002-2003, 30 were married women with NEAD.
  
  
  METHODS
  The diagnostic criteria for NEAD included normal EEG during ictal and post-ictal phase of the generalized 'attack.' The data collected included clinical characteristics, semiology of the attacks, precipitating stressful events, and co-morbid psychiatric disorders. The control group included 30 age-matched married women with generalized tonic-clonic seizures. The long-term outcome and factors influencing the outcomes were analyzed.
  
  
  RESULTS
  The mean duration of illness was 18 months, and the pattern of the attack was 'fall and lying still' in 53% and 'fall with generalized motor movements' in 47%. The frequency was one or more per week in 57% and occasionally in 43%. The important stressful events were matrimonial discord following illegal relationship of the husband with another woman (chi2 = 9.02, P = 0.003) and constant quarrel with other family members (chi2 = 5.19, P = 0.02). The prevalence of sexual abuse was low (7%). Co-morbid psychiatric disorder was observed in 70%. At the end of 1 year, 39% were free from the attack. Resolution of the stressful life events (chi2 = 4.52, P = 0.03) and lower frequency of attack at the time of reporting (chi2 = 3.88, P = 0.05) correlated with good outcomes.
  
  
  CONCLUSIONS
  Among patients with NEAD in India, the major precipitating factors were matrimonial discord following illegal relationship of the husband with another woman and constant quarrel with other family members and not sexual abuse. Women with low frequency of attack at the time of reporting and the remission of the stressful events had better outcomes.
authors: Department of Neurology, Government Stanley Medical College and Hospital, Chennai, India. drmdhanaraj@yahoo.com
authors: M
authors: M
authors: Dhanaraj
authors: R
authors: R
authors: Rangaraj
authors: T
authors: T
authors: Arulmozhi
authors: A
authors: A
authors: Vengatesan
mesh_terms: D000328:Adult; D005190:Family; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008016:Life Change Events; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications*