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Epileptic seizures progressing into nonepileptic conversion seizures

From the Department of Neurology, New York University Medical Center, New York.

Address correspondence and reprint requests to Dr. Devinsky, Department of Neurology, Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003.

Background: Epileptic and nonepileptic seizures can occur in the same patient, but usually occur at different times. In 1885, Gowers suggested that minor seizures can elaborate into hysterical seizures, but the concurrence of epileptic and nonepileptic seizures is not well documented.

Methods: We reviewed all patients with nonepileptic seizures documented with video-EEG recordings at our center to identify those with temporally associated epileptic seizures.

Results: Four patients were identified in whom video-EEG-documented epileptic seizures were temporally associated with nonepileptic seizures. In one woman, the nonepileptic event followed an absence seizure. Given the high frequency of absence seizures, the occurrence of the nonepileptic seizure may have been coincidental. In three patients, the seizures were partial and arose from right frontotemporal regions. In these patients, epileptic seizures were infrequent.

Conclusions: Epileptic and nonepileptic seizures can be temporally related, and in patients with partial seizures, there may be a pathophysiologic relation in which ictal changes facilitate the development of conversion symptoms. Ictal activation or disinhibition of emotions or impulse control may contribute to these nonepileptic events.

Received May 20, 1998. Accepted in final form August 1, 1998.

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