Dissociative seizures Flashcards
what is the evidence for dissociative seizures
clinical judgement
non compliance with AEDs
telemetry
poor imitation of epilepsy
what percentage of people with dissociative seizures have epilepsy
15%
what are the demographic characteristics of DS
75% female
early age onset (teens to young adults)
delayed diagnosis
consequences of misdx
missed treatment opportunity
multiple trials of anticonvulsants
toxicity
status epilepticus
how are DS diagnosed
clinical judgement
interictal EEG
telemetry
EEG with provocation
which clinical features support a dx of DS
duration over 2 minutes
aware but unresponsive
eyes closed
fluctuating course
asynchronous movements
side to side head movements
pelvic thrusting
weeping
arc de cercle
violent movements
which clinical features support ds of epilepsy
post ictal stertorous breathing
post ictal confusion
automatisms
which features are unhelpful for dx
urinary incontinence
injury e.g. tongue biting
sterotyped events
reported seizures from sleep
which somatic symptoms arouse DS
palpitations
sweating
hyperventilation
paraesthesia
dry mouth
denial of panic
emotional relief following seizure
which clinical features are supportive (only)
failed response to AEDs
absence of risk factors for epilepsy
presence of risk factors for DS
what are risk factors for epilepsy
febrile convulsions
CNS infection
head injury
developmental problems
family hx
what are risk factors for DS
previous fnd symptoms
childhood trauma
past psychiatric hx
what is the relationship between PNES/ epilepsy and metaphors
patients with epilepsy have different preferences for metaphorical conceptualisations of seizure experiences compared to PNES
agent/force > space/place
what are the diagnostic features of EEG DS
- preserved alpha rhythm during apparent impaired consciousness
- ictal epileptiform discharges
- post-ictal slowing
serum prolactin
establish baseline
take blood 20 minues after seizure
which primary psychiatric disorder can be mistaken for epilepsy
anxiety
which psychiatric disorders are associated with dissociative seizures
personality disorders
somatoform disorder
depression
anxiety disorders
PTSD
what are possible bio-psycho predisposing factors for DS
smoatising trait
dissociative traint
avoidant coping style
emotional instability
mood disorder
epilepsy
what are possible social predisposing factors for DS
trauma
poor family functioning
modelling of symptoms
what are bio-psycho precipitating factors for DS
acute panic attack
syncope
what are social precipitating factors for DS
adverse life events
what are bio-psycho maintaing factors for DS
illness beliefs
agoraphobia
reaction to dx
what are social maintaining factors for DS
carers attitudes
sick role
which ictal symptoms are prevalence in patients with DS
ictal anxiety, avoidance behaviour and dissociation
