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Neuropsychiatric aspects of psychogenic status epilepticus

Department of Neurology, The Ohio State University College of Medicine, Clinical Neurophysiology Laboratory, and The Ohio State University Hospitals, The Ohio State University Comprehensive Epilepsy Program, Columbus, OH.

We studied 20 patients with continuous repetitive psychogenic seizures simulating status epilepticus. Most patients received intravenous doses of multiple anticonvulsants. Our definition used for status epilepticus was that of Delgado-Escueta et al,¹ at least 30 minutes of repetitive seizures without regaining consciousness. Nineteen of 20 patients were young women, all but one under 40 years of age. Sixteen of these patients had a history of childhood seizures. In over 50% of patients, seizures continued until respiratory arrest and intubation occurred. Thorough neuropsychological testing and psychiatric interview were done after cessation of the acute episode. Long-term outcome and prognosis depended on definitive psychiatric diagnosis. Repetitive psychogenic seizures simulating status epilepticus are not uncommon, and such patients may incur serious iatrogenic complications from treatment for status epilepticus. Appropriate management and long-term prognosis may be determined by the type and severity of the underlying psychiatric disorder.

Address correspondence and reprint requests to Dr. Ann Pakalnis, Department of Neurology, The Ohio State University College of Medicine, Room 430, Means Hall, 1654 Upham Drive, Columbus, OH 43210.

Supported in part by The Denman Fund for Epilepsy Research, The Ohio State University.

Presented in part at the 42nd annual meeting of the American Academy of Neurology, Miami Beach, FL, May 1990.

Received July 3, 1990. Accepted for publication in final form December 18, 1990.

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