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Cited by 70Psychosomatic Disorders and Their TreatmentsEpilepsy research and treatmentElectroconvulsive Therapy Studies

Clinical features and prognosis of nonepileptic seizures in a developing country

Open access
Silva, W., Giagante, B., Saizar, R., D′Alessio, L., Oddo, S., Consalvo, D., Saidón, P., Kochen, S.·2001·Epilepsia
DOI 10.1046/j.1528-1157.2001.45299.x
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Abstract

Purpose: To determine the predictive value of clinical features and medical history in patients with nonepileptic seizures (NESs). Methods: One hundred sixty-one consecutive ictal video-EEGs were reviewed, and 17 patients with 41 NESs identified. NES diagnosis was defined as paroxysmal behavioral changes suggestive of epileptic seizures recorded during video-EEG without any electrographic ictal activity. Clinical features, age, sex, coexisting epilepsy, associated psychiatric disorder, social and economic factors, delay in reaching the diagnosis of NES, previous treatment, and correlation with outcome on follow-up were examined. Results: The study population included 70% female patients with a mean age of 33 years. Mean duration of NESs before diagnosis was 9 years. Forty-one percent had coexisting epilepsy. The most frequent NES clinical features were tonicclonic mimicking movements and fear/anxiety/hyperventilation. The most common psychiatric diagnosis was conversion disorder and dependent and borderline personality disorder. Seventy-three percent of patients with pure NESs received antiepileptic drugs (AEDs), and 63.5% of this group received new AEDs. Fifty-nine percent of the patients received psychological/psychiatric therapy. At follow-up, 23.5% were free of NESs. Conclusions: All seizure-free patients had two good prognostic factors: having an independent lifestyle and the acceptance of the nonepileptic nature of the episodes. Video-EEG monitoring continues to be the diagnostic method to ensure accurate seizure classification. Establishing adequate health care programs to facilitate access to new technology in public hospitals as well as the implementation of continuous education programs for general practitioners and neurologists could eventually improve the diagnosis and treatment of patients with NESs.

Integrity signals

Registry

Crossref · 10.1046/j.1528-1157.2001.45299.x

Cites

41 of 41 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 21 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Seven (41%) patients accepted the nonepileptic nature of their seizures.

    “Seven (41%) patients accepted the nonepileptic nature of their seizures.”
    Quote in the paperSubstantial claim
  • Findingown data

    At follow-up, 23.5% of patients were free of NESs.

    “At follow-up, 23.5% were free of NESs.”
    • Also stated in: § RESULTS · plain
      “During the follow-up period, four (23%) patients were free of NESs, and 13 (77%) patients continued having seizures.”
    Quote in the paperSubstantial claim
  • Findingown data

    14 (82.3%) patients had an independent lifestyle.

    “The analysis of the social and economic features of the entire study population indicated that 14 (82.3%)patients had an independent lifestyle”
    Quote in the paperNot a substantial claim
  • Findingown data

    41% of patients had coexisting epilepsy, supported by interictal epileptiform EEG abnormalities and/or MRI.

    “Forty-one percent had coexisting epilepsy.”
    • Also stated in: § RESULTS · boosted
      “In seven (41.1%) patients, clear clinical evidence of coexisting epilepsy was found, supported by interictal epileptiform EEG abnormalities and/or magnetic resonance imaging (MRI).”
    Quote in the paperNot a substantial claim
  • Findingown data

    59% of patients received psychological/psychiatric therapy.

    “Fifty-nine percent of the patients received psychological/psychiatric therapy.”
    • Also stated in: § RESULTS · plain
      “Ten (59%) patients agreed to receive psychological/ psychiatric therapy.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 17
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 19

  • May combine two claims.

    Findingown data

    Two factors had a predictive value for a good outcome: the acceptance of the nonepileptic nature of the seizures and an independent lifestyle (RR 2.38; p < 0.05).

    “We found that two factors had a predictive value for a good outcome: the acceptance of the nonepileptic nature of the seizures and an independent lifestyle (RR ‫ס‬ 2.38; p < 0.05).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The most common personality disorders were dependent and borderline.

    “The most common psychiatric diagnosis was conversion disorder and dependent and borderline personality disorder.”
    • Also stated in: § RESULTS · plain
      “In Axis II (Personality Disorders): dependent, three (25%); borderline, three (25%); histrionic, one (5%); and mental retardation, one (95.8%)patient.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All seizure-free patients had two good prognostic factors: having an independent lifestyle and the acceptance of the nonepileptic nature of the episodes.

    “All seizure-free patients had two good prognostic factors: having an independent lifestyle and the acceptance of the nonepileptic nature of the episodes.”
    • Also stated in: § DISCUSSION · plain
      “In this study, all seizure-free patients had two good prognostic factors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Being female, the absence of coexisting epilepsy, and the existence of psychiatric or psychological treatment were not factors associated with a more favorable outcome.

    “Contrary to other authors' reports (7), it was not found that being female, the absence of coexisting epilepsy, or the existence of psychiatric or psychological treatment were factors associated with a more favorable outcome.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] 7. Meierkord H, Will B, Fish D, et al. The clinical features and prognosis of pseudoseizures diagnosed using video EEG telemetry. Neurology 1991;41:1643-6. source

  • May combine two claims.

    Findingown data

    Among the seven patients with coexisting epilepsy, six had a partial syndrome and one a generalized syndrome, all misdiagnosed as having refractory epilepsy.

    “Six patients had a partial syndrome, and one, a generalized syndrome, all misdiagnosed as having refractory epilepsy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The study population included 70% female patients with a mean age of 33 years.

    “The study population included 70% female patients with a mean age of 33 years.”
    • Also stated in: § RESULTS · plain
      “Among the 17 patients entered in the study, 12 (70%) were female and five (30%) were male patients; mean age, 33 years (range, 12-69 years).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All patients with NESs and ESs were treated with AEDs, and none received psychiatric pharmacologic treatment.

    “All patients with NESs and ESs were treated with AEDs, and none of them received psychiatric pharmacologic treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The most frequent NES clinical features were tonic-clonic mimicking movements and fear/anxiety/hyperventilation.

    “The most frequent NES clinical features were tonicclonic mimicking movements and fear/anxiety/hyperventilation.”
    • Also stated in: § RESULTS · plain
      “The most frequent NES clinical features were tonicclonic mimicking movements, nine (21.9%) patients; fear/anxiety/hyperventilation, nine (21.9%) patients; apparent decreased responsiveness and motionlessness, eight (19.5%)patients; mimicking automatism movements, five (12.1%) patients; vocalization, two (4.8%) patients; and head dropping, two (4.8%) patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The mean time of video-EEG recording was 6 h.

    “The mean duration of the video-EEG recording time was 6 h per patient (range, 2-16 h).”
    • Also stated in: § DISCUSSION · plain
      “The mean time of video-EEG recording was 6 h, similar to reports by Luther et al. (10).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] 10. Luther JS, McNamara JO, Carwile S, et al. Pseudoepileptic sei- zures: methods and video-analysis to aid diagnosis. Ann Neurol 1982;12:458-62. source

  • May combine two claims.

    Findingown data

    The most common psychiatric diagnoses were conversion disorder, posttraumatic stress disorder, and dissociative disorder, and the main personality disorders were dependent and borderline.

    “The DSM IV (21) criteria were applied, and it was found that the most common psychiatric diagnoses were conversion disorder, posttraumatic stress disorder, and dissociative disorder, and the main personality disorders were dependent and borderline.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] 21. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. DSM IV. Washington, DC: American Psychiatric Association, 1994.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Interpretationown data

    Video-EEG monitoring continues to be the diagnostic method to ensure accurate seizure classification.

    “Video-EEG monitoring continues to be the diagnostic method to ensure accurate seizure classification.”
    • Also stated in: § DISCUSSION · plain
      “Monitoring allowed confirming the efficacy of a single 3-h video-EEG recording for the diagnosis of NES.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Both ESs and NESs may coexist in the same patient.

    “Furthermore, both ESs and NESs may coexist in the same patient (4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] 4. Ozkara C, Dreifuss FE. Differential diagnosis in pseudoepileptic seizures. Epilepsia 1993;34:294-8. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Long-term video-EEG monitoring (LVEM) has completely changed the diagnosis of NES and allowed several groups of researchers to describe the different clinical signs observed.

    “Long-term video-EEG monitoring (LVEM) has completely changed the diagnosis of NES and allowed several groups of researchers to describe the different clinical signs observed (1,2,(5)(6)(7)(8).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (1,2,(5)(6)(7)(8)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Psychogenic nonepileptic seizures (NESs) constitute a clinical phenomenon resembling epileptic seizures (ESs) and are very frequently misdiagnosed as such.

    “Psychogenic nonepileptic seizures (NESs), also known as pseudoseizures, constitute a clinical phenomenon resembling epileptic seizures (ESs) and are very frequently misdiagnosed as such (1)(2)(3)(4).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites (1)(2)(3)(4)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    One reason for the poor results in these patients undergoing psychiatric/psychological treatment may be a poor knowledge of this disease by mental health professionals.

    “One reason for the poor results in these patients undergoing psychiatric/psychological treatment may be a poor knowledge of this disease by mental health professionals.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The difference in prevalence of fear, anxiety, and hyperventilation could be due to different criteria used to classify clinical features of NESs, or due to a different approach and cultural background.

    “It was considered that this difference in prevalence of these symptoms could be due to the different criteria used by the individual authors to classify clinical features of NESs, or due to a different approach and cultural background.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    General practitioners considering that psychogenic seizures are restricted to bizarre and neurologically incongruent behavior may be especially prone to a NES misdiagnosis in patients with only unresponsiveness.

    “General practitioners considering that psychogenic seizures are restricted to bizarre and neurologically incongruent behavior may be especially prone to a NES misdiagnosis in patients with only unresponsiveness.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    In spite of the difficulty of accurately defining the NES onset, it was estimated on the basis of history obtained through patients' contacts.

    “In spite of the difficulty of accurately defining the NES onset, we estimate it on the basis of history obtained through patients' contacts.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    As reported by Saidon et al., in Argentina only 9% of patients with refractory epilepsy were treated with new AEDs, mainly for economic reasons.

    “As reported by Saidon et al. (28), in Argentina only 9% of the patients with refractory epilepsy were treated with new AEDs, mainly for economic reasons”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] 28. Saidon P, Giagante B, Gonzalez L, et al. Follow-up of 256 patients with epilepsy treated with new anticonvulsant drugs in a develop- ing country. Epilepsia 1997;38(suppl 3):S74-5. source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Follow-up was obtained for all patients, between 6 months and 3 years after the diagnostic telemetry recording.

    “Follow-up was obtained for all patients, between 6 months and 3 years after the diagnostic telemetry recording, by diary review”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The delay in reaching the diagnosis of NESs (1-30 years) may be attributable to mistakes in distinguishing NESs from ESs and to the high costs and difficulties of implementing video-EEG in this country.

    “The delay in reaching the diagnosis of NESs (1-30 years) may be attributable to two reasons.In the first place, mistakes may have been made when distinguishing NESs from ESs.The second probable factor includes the high costs and difficulties of implementing the video-EEG in this country, where only a small fraction of patients currently have access to this technology.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Economic problems prevent the implementation of adequate diagnostic techniques in Argentina.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    In a patient with well-characterized seizure phenomena, the appearance of a different type of episode may suggest NESs.

    “In a patient with well-characterized seizure phenomena, the appearance of a different type of episode may suggest NESs.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The confidence interval is too large to have actual statistical value because of the small sample size.

    “Because of the small size of the sample, the confidence interval is too large to have an actual statistical value.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    This outcome is similar to that reported by other authors.

    “This outcome is similar to that reported by other authors (31,32).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [31] 31. Carter AB. The prognosis of certain hysterical symptoms. BMJ 1949;1:1076-9. source
    • cites [32] 32. Lempert T, Schmidt D. Natural history and outcome of psycho- genic seizures: a clinical study in 50 patients. J Neurol 1990;237: 35-8. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The International League Against Epilepsy (ILAE) diagnostic criteria were used for the diagnosis of ES.

    “The International League Against Epilepsy (ILAE) diagnostic criteria were used for the diagnosis of ES (9).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] 9. Commission on Classification and Terminology of the Interna- tional League Against Epilepsy. Proposal for revised classification of epilepsy and epileptic syndromes. Epilepsia 1989;30:389-99. source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Patients with purely subjective phenomena were excluded because ictal epileptiform activity may not always be apparent during simple partial seizures.

    “Patients with purely subjective phenomena were excluded from the study, because ictal epileptiform activity may not always be apparent during simple partial seizures.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Whenever both types of disorders are present, the relative frequency of ESs and NESs may be difficult to determine.

    “Furthermore, whenever both types of disorders are present, the relative frequency of ESs and NESs may be difficult to determine.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A study performed in a developed country has shown the overuse of health-care services for patients with NESs who do not benefit from AEDs and, due to misdiagnosis, typically experienced detrimental psychosocial and social/economic outcomes.

    “A study (34) performed in a developed country has shown the overuse of health-care services for patients with NESs who do not benefit from AEDs and, due to misdiagnosis, typically experienced detrimental psychosocial and social/economic outcomes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] 34. Roy CM, Guilliam FG, Faught E, et al. Nonepileptic psychogenic seizures. Seizure 1998;6:1.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There have been considerable discrepancies regarding the incidence of true epilepsy coexisting in patients with pseudoseizures (ranging from 20 to 72%).

    “There have been considerable discrepancies regarding the incidence of true epilepsy coexisting in patients with pseudoseizures (ranging from 20 to 72%) (4,(17)(18)(19)(20).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (4,(17)(18)(19)(20)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    The condition may not respond to treatment because only NESs or ESs are identified.

    “The condition may not respond to treatment because only NESs or ESs are identified.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A revision of the published literature has shown that the criteria governing psychiatric diagnosis were based on different methods, thus complicating the comparison between different studies.

    “A revision of the published literature (22)(23)(24)(25)(26) has shown that the criteria governing psychiatric diagnosis were based on different methods, thus complicating the comparison between different studies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (22)(23)(24)(25)(26)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

31 of 31

  • The paper relies on this without support.

    Early identification of the existence of NESs is essential to determine appropriate therapy.

    “An early identification of the existence of NESs is essential to determine the appropriate therapy.”

  • The paper relies on this without support.

    Argentina is a developing country.

    “Because Argentina is a developing country, we have used LVEM only since 1990.”

  • The paper relies on this without support.

    Economic problems prevent the implementation of adequate diagnostic techniques in Argentina.

    “However, the process of diagnosis is difficult because of economic problems preventing the implementation of adequate diagnostic techniques.”

  • The paper relies on this without support.

    Most reports on this topic were carried out in developed countries.

    “Most reports on this topic were carried out in developed countries.”

  • The paper relies on this without support.

    NESs usually do not occur during apparent sleep and typically develop after the onset of ESs.

    “NESs usually do not occur during apparent sleep and typically develop after the onset of ESs.”

  • The paper relies on this without support.

    Patients with pseudoseizures frequently report coming from chaotic families.

    “Patients with pseudoseizures frequently report coming from chaotic families.”

  • The paper relies on this without support.

    Health resources are very limited, and this situation is worse in developing countries in view of the social and economic hardships.

    “Health resources are very limited, and this situation is worse in developing countries in view of the social and economic hardships.”
7 of 7

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Epilepsy subgroups exceed the study population

    Major

    The paper reports seven patients with coexisting epilepsy and 11 with pure NESs. These mutually exclusive groups total 18 patients, but the study includes only 17.

  • One patient cannot represent 95.8% of the cohort

    Minor

    One of 17 patients represents about 5.9%, not the reported 95.8%.

    Reported 95.8 · recomputed 5.882353

  • Clinical-feature percentages use a different denominator from the stated patient counts

    Minor

    Nine of the 17 patients would be 52.9%, not 21.9%. The reported percentage instead matches nine of the 41 recorded NESs, although the count is labeled as patients; the other listed clinical-feature percentages follow the same pattern.

    Reported 21.9 · recomputed 52.941176

  • Fear and anxiety are ranked second despite a tie for first

    Minor

    The discussion calls fear, anxiety, and hyperventilation the second most frequent signs, but the results assign them the same count as tonicclonic mimicking movements.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Anonymous, 1989, Pseudostatus epilepticus., Lancet, 1, 485

Cited by

Sorted by citations

Related

Authors
Silva, W., Giagante, B., Saizar, R., D′Alessio, L., Oddo, S., Consalvo, D., Saidón, P., & Kochen, S.
Affiliations
  • Consejo Nacional de Investigaciones Científicas y Técnicas (AR)
  • Hospital Ramos Mejía (AR)
Corresponding author
  • Silva, W.
  • Kochen, S.
ORCID
Venue
Epilepsia
Publisher
Wiley
Published
2001-03-09
Volume
42
Issue
3
Pages
398-401
ISSN
  • 0013-9580 (ISSN-L)
  • 1528-1167
DOI
10.1046/j.1528-1157.2001.45299.x
OpenAlex
W2084246226
Cited by
70
References
39
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 4 · 2017: 6 · 2016: 2 · 2015: 2 · 2014: 3 · 2013: 5 · 2012: 5
FWCI
1.49
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 418 d)
Locations
  • Epilepsia (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Keywords
non-epileptic seizures, conversion disorder, prognosis, clinical features, video-EEG monitoring, antiepileptic drugs, psychiatric comorbidity, personality disorders, seizure misdiagnosis, health care access, developing countries
MeSH terms
Adolescent, Adult, Aged, Anticonvulsants, Argentina, Attitude to Health, Mental Disorders, Child, Developing Countries, Epilepsy, Female, Follow-Up Studies, Humans, Life Style, Male, Middle Aged, Prognosis, Risk Factors, Seizures, Somatoform Disorders, Comorbidity, Outcome Assessment, Health Care, Age of Onset

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