Chapter 13 - Dissociative seizures

Summary

This chapter discusses the epidemiology, diagnosis, classification, prognosis, treatment and management of dissociative seizures. The majority of patients with pseudo status epilepticus have a severe underlying psychiatric illness; most common is a personality disorder of the borderline type. The prognosis of patients with dissociative seizures is not simply dependent on seizure freedom. The diagnosis of dissociative seizures should be made with care and never on the basis of a single sign or symptom. Psychiatric co-morbidity has been reported in 40% to 100% of patients, including the entire diagnostic spectrum of psychiatric disorders. The use of psychotropic medication is largely dependent on whether an associated psychiatric condition such as depression or post-traumatic stress disorder (PTSD) can be diagnosed. The prognosis of dissociative seizures is certainly worse compared to epilepsy. According to a synopsis of 16 studies, only 37% of patients reach seizure freedom following a follow-up of 39 months.