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Background: Nonepileptic seizures are involuntary episodes of movement, sensation, or behaviors (e.g., vocalization, crying and other expressions of emotion), that do not result from abnormal cortical discharges. The events typically occur in teenage patients with anxiety and affective disorders. Psychotherapy, behavioral therapy, drugs, hypnosis and placebo are mainstay of treatment. There is no published data on clinical characteristics of pseudo-seizures from Pakistan. The objective of our study is to describe the clinical characteristics of pseudoseizures in a tertiary care hospital in Karachi, Pakistan. Methods: This is a descriptive study. Patients with pseudo-seizures were identified from departmental Video EEG monitoring register, over a period of three years (2004 2006). Their neurophysiologic and video recording data was reviewed and their demographic, clinical and neurophysiologic data was recorded and analyzed. SPSS version 15.0 was used for analysis.
Results: A total of 132 patients underwent video EEG during the period and 51 (38%) had pseudo-seizures. Their mean age was 26.7±15.3 years. Thirty-two (63%) were female and 19 (37%) were male. Twelve (23.5%) patients were known epileptics. Median recording time was 24 (range; 0.33 55) hours and median number of events was 3 (range; 1 14). Limb movements were most common manifestation (67%) followed by muteness with no response to verbal commands (49%), behavioral symptoms (35.5%), ocular findings i.e. eye blinking and closure (25.5%), depressed conscious level (13.7%), headache (10%) and GI symptoms (10%). Six (11.8%) patients experienced epileptic seizures, in addition to pseudo-seizures.
Conclusions: Pseudo-seizures are common in patients referred for video EEG monitoring. It is more common in young women. Limb movements, muteness and behavioral symptoms are most common manifestations. The pseudo-seizures and epileptic seizures may coexist in the same patient.


Clinical Neurophysiology

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