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Provocative Techniques Should Be Used for the Diagnosis of Psychogenic Nonepileptic Seizures
Selim R. Benbadis, MD
From the Departments of Neurology and Neurosurgery, University of South Florida and Tampa General Hospital, Tampa.
Arch Neurol. 2001;58:2063-2065.
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Ye shall know the truth, and the truth shall make you mad.—Aldous Huxley
You never find yourself until you face the truth.—Pearl Bailey
PSYCHOGENIC symptoms are ubiquitous in medicine, both in and outside of neurology.1-3 Psychogenic nonepileptic seizures (PNES) are commonly seen at epilepsy centers, where they represent at least 20% of patients referred for refractory "seizures."4-5 Their estimated prevalence in the general population is 2 to 33 per 100 000, making this problem nearly as common as multiple sclerosis or trigeminal neuralgia.6
While PNES can be suspected on clinical grounds, there is no clinical feature that is absolutely diagnostic. Approximately 80% of patients diagnosed with PNES have received a diagnosis of epilepsy along with antiepileptic drugs,7 indicating that PNES are difficult to diagnose and are often misdiagnosed. Yet neurologists have the (unusual) luxury of a very reliable diagnostic tool — electroencephalogram (EEG) video monitoring — with . . . [Full Text of this Article] WHY DO INDUCTIONS?
ETHICAL PROBLEMS WITH INDUCTIONS
TWO ANSWERS TO THE ETHICAL OBJECTIONS
The Theoretical Justification The Pragmatic Solution
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