title: [What the patient's history tells us about their nonepileptic seizures].
abstract: The aetiology of "psychogenic" non-epileptic seizures (NES) remains poorly understood and the differentiation of NES from epilepsy can be a difficult. In the first part of this review article we focus on recent insights into the neurobiological underpinnings of NES. We summarise a number of studies demonstrating the importance of abnormalities of emotion regulation in patients with NES. Evidence for abnormal emotion regulation comes from both self-report and experimental studies of pre-conscious cognitive processes. These studies show that NES are not the only manifestation of abnormal mental processing in these patients and that excessive social threat avoidance and emotional dysregulation are also evident between seizures and may therefore contribute to disability beyond the seizures themselves. In the second part of this review, we describe the findings of a number of studies, which have examined differences between the communication behaviour of patients with NES and those with epilepsy. We argue, that, whilst these studies initially aimed to help clinicians with the differential diagnosis of NES and epilepsy, close sociolinguistic analysis of patient's talk can also provide clues about the aetiology of NES. We conclude that the interaction of patient with NES with the doctor can be interpreted as a manifestation of avoidance and a demonstration of helplessness perhaps intended to secure active support from the doctor. In the third part of this review, we suggest that a close reading of a transcript of the interaction between a patient with NES and her doctor (and perhaps attentive listening to how patients' talk about themselves and their disorder) can yield clues to the causes of NES in individual cases.
authors.affiliation: Academic neurology unit, university of Sheffield, Royal Hallamshire hospital, Glossop Road, Sheffield S10 2JF, Royaume-Uni. Electronic address: mreuber@doctors.org.uk.
authors.forename: M
authors.initials: M
authors.lastname: Reuber
authors.affiliation: Solaris, pôle de psychiatrie universitaire, hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; UMR CNRS 7291, laboratoire de neurosciences cognitives (LNC), 31 Aix-Marseille université, site Saint-Charles, 3, place Victor-Hugo, 13331 Marseille cedex 3, France. Electronic address: jean-arthur.micoulaud@ap-hm.fr.
authors.forename: J-A
authors.initials: JA
authors.lastname: Micoulaud-Franchi
authors.affiliation: FakultätfürLinguistik und Literaturwissenschaft, Universität Bielefeld, Postfach 10 01 31, 33501 Bielefeld, Allemagne. Electronic address: elisabeth.guelich@gmx.de.
authors.forename: E
authors.initials: E
authors.lastname: Gülich
authors.affiliation: Inserm, U1106, institut de neuroscience des systèmes, 13005 Marseille, France; Faculté de médecine, Aix-Marseille université, 13005 Marseille, France; Service de neurophysiologie clinique, Assistance publique des Hôpitaux de Marseille, CHU de la Timone, 13005 Marseille, France. Electronic address: fabrice.bartolomei@ap-hm.fr.
authors.forename: F
authors.initials: F
authors.lastname: Bartolomei
authors.affiliation: Inserm, U1106, institut de neuroscience des systèmes, 13005 Marseille, France; Faculté de médecine, Aix-Marseille université, 13005 Marseille, France; Service de neurophysiologie clinique, Assistance publique des Hôpitaux de Marseille, CHU de la Timone, 13005 Marseille, France. Electronic address: aileenmcg@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: McGonigal
mesh_terms: D003937:Diagnosis, Differential; D004827:Epilepsy / Q000175:diagnosis; D006801:Humans; D010817:Physician-Patient Relations; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology
keywords: Aetiology; Analyse conversationnelle; Conversation analysis; Crises non épileptiques psychogènes; Diagnostic différentiel; Differential diagnosis; Epilepsy; Psychogenic non-epileptic seizures; Épilepsie; Étiologie