title: Dissociative seizures: a challenge for neurologists and psychotherapists.
abstract: BACKGROUND
  The prevalence of dissociative seizures is between 2 and 33 sufferers per 100,000 persons. 70% of sufferers are women. Dissociative seizures markedly impair quality of life. Their close superficial resemblance to epileptic seizures makes them hard to diagnose.
  
  
  METHODS
  Selective literature search in PubMed and PsycINFO.
  
  
  RESULTS
  Persons with dissociative seizures constitute a mixed group with a wide variety of predisposing, precipitating, and maintaining factors. Some 90% have comorbid psychiatric disorders such as depression, anxiety, somatoform disorders, personality disorders, or post-traumatic stress disorder. Video-EEG monitoring enables highly reliable diagnosis. Psychotherapy is considered the treatment of first choice; in prospective studies, it has been found to lower the frequency of dissociative seizures by at least 50%, or to eliminate them completely, in 50% to 80% of patients. An individually tailored combination of behavioral therapeutic, imagery-based, and psychodynamic approaches seems reasonable. For the treatment of psychiatric comorbidities, psychotherapy is indicated, in combination with psychoactive drugs if necessary. Before any treatment is provided, the diagnosis should be communicated to the patient in an appropriate way, ideally by both the neurologist and the psychotherapist, so that the patient can develop an alternative disease model.
  
  
  CONCLUSIONS
  When the diagnosis of dissociative seizures has been made, psychotherapy is indicated, possibly in combination with psychoactive medication, in the setting of long-term treatment provided in collaboration by the neurologist, psychiatrist, psychotherapist, and family physician. Further randomized trials are needed to determine which treatments are best for which subgroups of patients.
authors.affiliation: Department of Psychosomatic Medicine, University Medical Center Freiburg, Germany. kurt.fritzsche@uniklinik-freiburg.de
authors.forename: Kurt
authors.initials: K
authors.lastname: Fritzsche
authors.forename: Kathrin
authors.initials: K
authors.lastname: Baumann
authors.forename: Katrin
authors.initials: K
authors.lastname: Götz-Trabert
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulze-Bonhage
mesh_terms: D003937:Diagnosis, Differential; D004213:Dissociative Disorders / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011613:Psychotherapy / Q000379:methods*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012640:Seizures / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D011619:Psychotropic Drugs