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From the Division of Restorative Neurology and Human Neurobiology (Dr. Leis), Baylor College of Medicine, Houston, TX; and the Department of Neurology (Drs. Ross and Summers), University of Iowa Hospitals and Clinics, Iowa City, IA.
We analyzed ictal features of psychogenic seizures using video-EEG recordings in 47 patients and reviewed the medical records to determine if patients received antiepileptic drug therapy and whether they were treated pharmacologically for status epilepticus. Unresponsive behavior in the absence of motor manifestations was the single most common ictal presentation. Motor characteristics previously considered to distinguish psychogenic seizures (out-of-phase limb movements, side-to-side head movements, pelvic thrusting) were infrequent. Most patients (74%) received anticonvulsants, and six were treated as status epilepticus. Slow, subtle writhing or in-phase limb movements were most likely to be mistaken for status epilepticus. Physicians, assuming that the spells constituted a neurologic emergency, omitted the neurologic examination and chart review and proceeded with aggressive pharmacotherapy based merely on observation.
Address correspondence and reprint requests to Dr. A. Arturo Leis, Division of Restorative Neurology and Human Neurobiology, Baylor College of Medicine, Smith Tower-Suite 1901, 6550 Fannin, Houston, TX 77030.
Received April 12, 1991. Accepted for publication in final form July 2, 1991.
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