Diagnosis and management of dissociative seizures

Up to one in five people diagnosed with epilepsy will turn out to have dissociative seizures (DS)  psychologically mediated episodes of altered awareness and/or behaviour that may mimic any type of epilepsy1,2. These patients are typically treated with antiepileptic medication for a number of years before the correct diagnosis is made. During this time they are exposed to significant iatrogenic risks including drug toxicity, teratogenic risk (most patients are young women) and the risk, in approximately 10%, of receiving emergency treatment for ‘status’3,4. By the time the correct diagnosis is made many patients and their families have already adapted their lives to chronic disability. For some, a medical ‘sick role’ seems preferable to a psychiatric one from the start. For the majority, however, years of inappropriate medical interventions will have reinforced the patients’ view of themselves as medically disabled. The one factor consistently associated with a better prognosis in this and other functional disorders is a short duration of illness at the time of diagnosis: in other words, prompt diagnosis5. How to recognise and treat DS is therefore an important subject for all clinicians working in the field of epilepsy.