Talk:Psychogenic non-epileptic seizures

From Wikipedia, the free encyclopedia

Contents 1 Psychogenic seizures not psychogenic? 2 Flashlight seizures 3 Why is 'seizures' plural in the article name? 4 Revert to recent edit. 5 Names 5.1 Non-epileptic Attack Disorder 5.2 Non-epileptic seizures 5.3 Pseudoseizures 6 what can cause them?

[edit] Psychogenic seizures not psychogenic?

I removed the assertion that psychogenic seizures are not psychogenic. This article is about psychogenic seizures. Other sorts of seizures, non-psychogenic in origin, are detailed in articles listed under 'see also'. Repeatedly explaining, in an article called "psychogenic seizures," that psychogenic seizures are not psychogenic is confusing and ultimately pointless. This would be similar to repeated assertions in the article entitled Dog, that dogs are not in fact dogs but are cats.

If someone wants to create a section entitled "Controversy," with text along the lines of "Some authorities have stated that psychogenic seizures do not exist per se," that might be a good idea. It would need, however, to be cited, as with any other contribution to Wikipedia, because Wikipedia forbids original research. I am eager, of course, to learn of the existence of any such verifiable statements, and strongly suggest that if they exist they be placed into the article.

-ikkyu2 (talk) 23:13, 12 April 2006 (UTC)

[edit] Flashlight seizures

Photosensitive epilepsy are of an epilepic origin ,and shouldt be a part of this article The Procrastinator 21:57, 29 December 2005 (UTC)

I think what you meant to say is that photosensitive epilepsy is non-epileptic in origin and should be a part of this article. Both assertions are wrong. -Ikkyu2 02:47, 30 December 2005 (UTC)

[edit] Why is 'seizures' plural in the article name?

The article discusses a syndrome of recurrent seizures which has no better singular name. An isolated psychogenic seizure does not qualify as conversion disorder, does not require treatment, and in general is different than the syndrome which is discussed in the article. Refer to [1] for more. -Ikkyu2 23:42, 20 January 2006 (UTC)

[edit] Revert to recent edit.

A recent edit included the following text, which I've reverted. Discussion follows:

In the past the patient with psychogenic non-epileptic seizures was thought to have a history of childhood physical abuse or sexual abuse or other severe emotional trauma. Treatment, with cognitive therapy or behavioral therapy, would be focused on strategies to recognize the onset of the seizures and use techniques to abort them, or to interrupt the stimulus-response pathway that produces them.

This is now largely discredited with only a few Psychiatrists willing to pursue this line. These tend to be non-organic such as the leading exponent Douglas Turkington who has led research into the abuse causes of seizures. Turkington holds that even though the patient and their family may not remember the abuse this is because the abuse is repressed (see Freud and the unconscious). As no empirical proof can be provided for this theory other specialists regard such theories as pseudo-science.

This is even more true given the fact that most epilepsy specialists recognise that a) some seizures, especially complex frontal lobe, are very hard to diagnose b) respone to medication is no indication of the pseudo nature of the seizure as patients diagnosed with epilepsy frequently do not respond to treatment.

• "In the past, the patient with PNES was thought to have a history of childhood physical or sexual abuse." That's not what this paragraph, which I wrote, originally said. It said that such patients were often found to give such a history. That's still true, and I've reverted it to say "sometimes found to give such a history." Mangling text - sourced text, no less - to distort its meaning and then rebutting it is poor editing form, and I request that you not do so in the future.

• According to Betts, 1997, in EPILEPSY: A COMPREHENSIVE TEXTBOOK, (see article for reference) cognitive behavioral therapy is still the mainstay of treatment technique. If you are going to cite a different theory, such as Mr Turkington's, please provide a verifiable reference published by a reputable source.

• The paragraph about frontal lobe seizures is not relevant to an article section about the treatment of non-epileptic seizures. Non-epileptic seizures are not caused by epilepsy. If you wish to assert, in an article called 'Psychogenic non-epileptic seizures,' that non-epileptic seizures are caused by epilepsy, I suggest creating a section called 'Criticism' or 'Controversy' and placing your assertions there. If the assertions are not verifiably referenced, they will be removed.

ikkyu2 (talk) 19:43, 16 February 2006 (UTC)

Also, honestly, I can't understand how editors to this page can use the term pseudoseizures, right after the introduction to the article asserts that that term should never be used. I encourage people thinking of editing the article to read it first. If you're going to write paragraphs about pseudoseizures, at least delete the part where the article admonishes readers never to use the term. ikkyu2 (talk) 03:37, 17 February 2006 (UTC)

[edit] Names

[edit] Non-epileptic Attack Disorder

I've created Non-epileptic attack disorder (NEAD) as a redirect to this excellent article. It appears that there is a US/UK split on terminology here, possibly resulting from the influence of Dr Tim Betts (former editor of the journal Seizure and advisor to Epilepsy Action). The two big UK charities have articles referring to NEAD rather than PNES (Epilepsy Action, The National Society for Epilepsy). Searches for NEAD on PubMed tend to show UK research.

I wonder if it we should mention "Non-epileptic Attack Disorder (NEAD)" in the article - otherwise folk may wonder if it is a different thing. I do think there is a subtle difference between NEAD and PNES. NEAD, in using the term "Disorder" appears to be more like a diagnosis/disease. Whereas PNES is a label for symptoms or the manifestation of a disease. (Apologies if I'm not using the precise medical terms here).

Ikkyu2 - The NSE online article mentioned above is written by Tim Betts, who is also the author of one of your references. I can't read the book. However, reading the online article I suspect the article and the chapter have much in common. If you agree, I suggest this article be added to either the External Links or perhaps in the References as an option for those unable to consult the book.

I agree without any reservation. -ikkyu2 (talk) 21:22, 1 March 2006 (UTC)

[edit] Non-epileptic seizures

Non-epileptic seizures is currently a redirect to this article. There is much confusion online as to whether NES is exactly equivalent to PNES. Many NES articles appear to be discussing only psychological causes. Some online articles discussing NES split them into physiological causes and psychogenic causes. I guess the former group get less written attention and are less likely to be given the label "NES" for any length of time, since the patient is then quickly then diagnosed with (and treated for) their physiological condition. I suspect most NES articles are written by folk who are only interested in the PNES aspect.

The book "Differential Diagnosis in Adult Neuropsychological Assessment" (ISBN 0826116655) has a section headed "Non-Epileptic Seizures" on p109. This says "Non-epileptic seizures are seizures that do not original from a primary neurological cause in the brain. The two types of non-epileptic seizures are physiological and psychogenic. Physiological non-epileptic seizures are caused by medical conditions in an organ system other than the brain, such as cardiovascular abnormalities, most commonly syncope. ...". I can't read any of the book "Non-Epileptic Seizures, 2nd edition" (ISBN 0750670266), but from its contents listing it does not appear to discuss physiological conditions.

I wonder if it would be good to promote non-epileptic seizures to being an article of its own. The contents of the "Other non-epileptic seizures" section could go there, as could some of the similar material in the "Diagnosis" section of the epilepsy article. Both this article and the epilepsy article could then have a "See also" to NES. The DAB link at the top of seizure could then point at Non-epileptic seizures.

An even more radical thought would be to move seizure to epileptic seizure and make seizure into a DAB article. I would vote for that since I think it is best to be specific in the name of the article.

I agree; I think all 3 of these articles should at least link to each other in their See also sections. -ikkyu2 (talk) 21:22, 1 March 2006 (UTC)

With regard to the idea of promoting non-epileptic seizures to its own article, I think that the things that are non-epileptic seizures divide into two categories: psychogenic seizures, and misdiagnosis. People can shake during a syncopal attack, but that doesn't make it a seizure; it makes it a syncope that can be misdiagnosed as a seizure. People can lose the thread of conversation during a migraine aura, but that doesn't make it a non-epileptic complex partial seizure; it's still a migraine headache. People can shake all over due to non-epileptic myoclonus, but what's the point of calling that a seizure? It's myoclonus. These things are not seizures, unless you want to warp the word seizure to mean something that no one expects it to mean, and I don't think that's a particularly good idea. -ikkyu2 (talk) 01:58, 3 March 2006 (UTC)

I agree with what you've said, from a precise and medical point-of-view. Can I just check – do you no longer think it is useful to create such an article? I still think it is possible to have a Non-epileptic seizures article that carefully discusses the two causes (physiological and psychogenic) and does indeed mention that (after investigation and diagnosis) the former would then be no longer called a seizure by a physician, but he/she would then use the more accurate term appropriate for the actual underlying disease.

However, I think the public use the term seizure in a more general sense than a careful physician would. In the medical world, with the need not to cause any confusion, the term has become exclusively associated with epileptic seizures. Some non-medical dictionary definitions are (excluding the act of taking something):

• A sudden attack (as of disease) <an epileptic seizure> – Webster's
• A very sudden attack of an illness involving unconsciousness or violent movement – Cambridge Advanced Learner's Dictionary
• OLD USE a sudden failure of the heart – Cambridge Advanced Learner's Dictionary
• A seizure is also the sudden loss of control of your muscles and, often, the loss of consciousness, caused by certain medical conditions – Cambridge Dictionary of American English
• a sudden manifestation or recurrence of a disease, such as an epileptic convulsion – Collins
• a sudden attack of illness, especially a stroke or an epileptic fit. – Compact Oxford English Dictionary
• A sudden attack, spasm, or convulsion, as in epilepsy or another disorder – The American Heritage Dictionary of the English Language
• The meaning "sudden attack of illness" is attested from 1779 – Online Etymological Dictionary

In my research for List of people believed to have epilepsy, I have read many news stories where the words seizure or fit are used very casually. Any article should be clear on the medical profession's use of the term seizure. At the same time, we must accept that people will call all sorts of things a seizure. --Colin Harkness 13:58, 3 March 2006 (UTC)

I think I'm handicapped by my POV on this one. I've studied this for so many years, and I'm so convinced I'm right :) , that it's hard for me to know exactly what the more typical encyclopedia reader would find useful. -ikkyu2 (talk) 00:30, 7 March 2006 (UTC)

[edit] Pseudoseizures

Whilst I agree the term pseudoseizures is unsatisfactory, we have perhaps yet to find the ideal term. See PMID 14630495 for a study from the patient's point of view. The following statistics are also interesting:

• non-epileptic attack disorder - 19 PubMed Articles, 281 Google results
• psychogenic non-epileptic seizures - 25 PubMed Articles, 477 Google results
• non-epileptic seizures - 92 PubMed Articles, 16,300 Google results, this recent book on Amazon: ISBN 0750670266
• pseudoseizures - 233 PubMed Articles, 25,100 Google results, this recent book on Amazon: ISBN 1904424279

The term pseudoseizures still appears in recent articles and books - it is not going away quickly --Colin Harkness 17:58, 17 February 2006 (UTC)

Well, it redirects here (to PNES) in both singular and plural forms, and it's bolded in the introduction. It's deprecated for good reasons - it's stigmatizing and strictly inaccurate. I would say that it is going away about as quickly as the term 'epileptic idiot' went away in terms of describing the developmentally delayed person with epilepsy, which is to say, no conceivable speed could be fast enough. -ikkyu2 (talk) 21:22, 1 March 2006 (UTC)

This isn't just my own personal POV, by the way; although it happens to be, it is also clearly explained, in exactly the way it's explained here in the linked article from the Epilepsy Foundation on PNES. -ikkyu2 (talk) 02:00, 3 March 2006 (UTC)

[edit] what can cause them?

i was wondering what sort of things can cause seizures? i read party pills can as can low blood sugars but i was wondring about like alchohol and thing like that???? (203.109.241.127 03:48, 25 March 2006 (UTC))

This isn't the relevent article to answer your question. Have a look at Epilepsy:Causes, though that doesn't really cover one-off seizures. Seizures can be provoked by taking certain drugs and alcohol (and also during withdrawal). Colin Harkness°^Talk 10:08, 25 March 2006 (UTC)