RowanGatesNON-EPILEPTIC SEIZURES1993Butterworth-HeinemannBoston

Whether they are called pseudoseizures, non-epileptic seizures, non-epileptic attack disorder, psychogenic seizures or paroxysmal somatoform disorder, 'attacks resembling or mistaken for epilepsy but which do not have the characteristic electrophysiological changes in the brain detectable by electroencephalography which accompany a true epileptic seizure" are common, easily overlooked, often mismanaged and puzzling both to neurologists and psychiatrists. A few years ago physicians were undoubtedly overdiagnosing epilepsy and exposing people with what was basically a psychological disorder to unnecessary anticonvulsants. Possibly now we are doing the reverse and making the diagnosis of non-epileptic seizures too readily and without sufficient knowledge of some of the wilder shores of epilepsy (particularly frontal and sensori-motor seizures). Interestingly, as our knowledge of the limitations of the technology of ictal EEG recording increases so in some ways our certainty of diagnoisis of non-epilepsy decreases. Even if we have made the correct diagnosis of a non-epileptic seizure (an unfortunate diagnostic grey area still exists where we cannot be certain particularly if, for ethical of practical reasons, we cannot take investigation far enough), we still have to decide how best to help the patient. Are they all the same? Do they have different aetioiogies? Will one management strategy do for them all or do we have to employ different strategies for individual non-epileptic seizure types? These are all questions to which there is as yet no definite or certain answer and although there is an extensive literature on non-epileptic seizures it is widely scattered between neurological and psychiatric journals and much of it is now rather old. Does this new book, based on the proceedings of a successful conference on non-epileptic seizures held in Fort Lauderdale in 1990, help the embattled practitioner? It certainly does. This is undoubtedly the best book on non-epileptic seizures currently available and although the conference was held 4 years ago the book is up to date although it very much concentrates on American experience and the American literature. The book also reflects the ready availability in the US of combined video EEG monitoring (a luxury available only to a few in the UK). In fact I wondered at several points in the book if this facility was too readily available in the States! In some of the chapters in the book there is the implication that a normal scalp EEG during a seizure of whatever sort unequivocally means it is a non-epilepdc seizure. Although …