This Article Figures Only Full Text Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Benbadis, S. R. Articles by Swanson, S. J. Search for Related Content PubMed PubMed Citation Articles by Benbadis, S. R. Articles by Swanson, S. J.

NEUROLOGY 1996;47:63-67
© 1996 American Academy of Neurology

Preictal pseudosleep

A new finding in psychogenic seizures Selim R. Benbadis, MD, Marcelo E. Lancman, MD, Lynn M. King, REEGT and Sara J. Swanson, PhD

From the Medical College of Wisconsin, Department of Neurology (Drs. Benbadis and Swanson and Ms. Wolf), Comprehensive Epilepsy Program, Milwaukee, WI; and the Department of Neurology (Dr. Lancman), New York Medical College & Westchester Medical Center, Comprehensive Epilepsy Center, Valhalla, NY.
Presented in part at the annual meeting of the American EEG Society, September 7 to 12, 1995, Washington, D.C.
Received September 20, 1995. Accepted in final form January 11, 1996.
Address correspondence and reprint requests to Dr. Selim R. Benbadis, Department of Neurology, Cleveland Clinic Florida, 3000 W. Cypress Creek Road, Fort Lauderdale, FL 33309.

Background and objective: The diagnosis of psychogenic seizures (pseudoseizures) may be difficult and usually rests on video-EEG monitoring. We observed that pseudoseizures often arise out of a state that we termed preictal pseudosleep. The objective of this study was to investigate this potential new sign in pseudoseizures. Methods: We prospectively studied all patients who underwent noninvasive monitoring over a 10-month period. Patients were monitored for a duration of 1 to 19 days (mean 4.9), and were divided into two groups: pseudoseizures and epileptic seizures. Patients with both conditions were excluded. Preictal pseudosleep was defined as a state that resembled normal sleep by behavioral criteria alone (i.e. patient motionless and eyes closed), while EEG showed evidence of wakefulness (alpha rhythm, active EMG, and rapid eye movement). This state had to be sustained for at least 1 minute before clinical onset. Results: Patients had 1 to 25 (mean 7) clinical events recorded. Preictal pseudosleep was seen in 10 of 18 patients with pseudoseizures and in none of 39 patients with epileptic seizures, yielding a sensitivity of 56% and a specificity of 100% for pseudoseizures. Conclusion: Because of a high specificity, preictal pseudosleep may be a useful adjunctive finding to support the diagnosis of pseudoseizures.

NEUROLOGY 1996;47: 63-67

This article has been cited by other articles:

				R. L. Marchetti, D. Kurcgant, J. G. Neto, M. A. Von Bismark, and L. A. Fiore Evaluating Patients With Suspected Nonepileptic Psychogenic Seizures J Neuropsychiatry Clin Neurosci, August 1, 2009; 21(3): 292 - 298. [Abstract] [Full Text] [PDF]

				R Duncan, M Oto, A J C Russell, and P Conway Pseudosleep events in patients with psychogenic non-epileptic seizures: prevalence and associations J. Neurol. Neurosurg. Psychiatry, July 1, 2004; 75(7): 1009 - 1012. [Abstract] [Full Text] [PDF]

				S. R. Benbadis Provocative Techniques Should Be Used for the Diagnosis of Psychogenic Nonepileptic Seizures Arch Neurol, December 1, 2001; 58(12): 2063 - 2065. [Full Text] [PDF]

				S. R. Benbadis, V. Agrawal, and W. O. Tatum IV How many patients with psychogenic nonepileptic seizures also have epilepsy? Neurology, September 11, 2001; 57(5): 915 - 917. [Abstract] [Full Text] [PDF]

				E. Wyllie, J. P. Glazer, S. Benbadis, P. Kotagal, and B. Wolgamuth Psychiatric Features of Children and Adolescents With Pseudoseizures Arch Pediatr Adolesc Med, March 1, 1999; 153(3): 244 - 248. [Abstract] [Full Text] [PDF]