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Nonepileptic Seizures: An Honest Approach to Provocative Testing Is Feasible
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We would like to comment on the recent interesting series of articles
on the use of provocative testing in the diagnosis of psychogenic nonepileptic
seizures.1-3
As stated by all of the authors, to date there is a lack of evidence for the
usefulness of the techniques described.
We have recently completed the first randomized controlled trial of
simple suggestion techniques during outpatient videoelectroencephalography
in patients with suspected psychogenic nonepileptic seizures.4
Contrary to many previous studies, we told all patients that a possible psychological
cause for the disorder was being considered and that recording a typical attack
was necessary to help reach a diagnosis. This approach avoided the ethical
problems of nondisclosure. Despite this degree of honesty, we still found
a high yield of attacks. In our experience, an honest approach is feasible
and less likely to be detrimental to the physician-patient relationship.
Aileen McGonigal, MRCP;
Maria Oto, MRCGP;
Aline J. . . . [Full Text of this Article]
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