The Paroxysmal Disorders: Insights into the controversy of medical diagnosis and terminologies

Recurrent, episodic conditions in medicine (paroxysmal disorders) have been seriously neglected in many ways. They require more adequate terminology, delineation of diagnostic criteria, appreciations of the conditions in all the different ethicobiopsychofamiliosociocultural contexts, and awareness of the need for management after adequate evaluation. This has led by necessity to the development of various historical measures that can be administered in a standard way—the Inventory of Neppe of Symptoms of Epilepsy and the Temporal Lobe (INSET) and Soft Organic Brain Inventory of Neppe (SOBIN) particularly as well as specialized investigations such as Home Ambulatory Electroencephalography (AEEG). The new condition of Paroxysmal Neurobehavioral Disorder is presented for the first time in publication. The difficulties of differentiating between atypical epileptic seizures and non-epileptic events are tabulated in detail. The name, Paroxysmal Somatoform Disorder, is revived as far the most appropriate though largely synonymous with the preceding labels of Hysteroepilepsy, Hysteroseizures, Pseudoseizures and Nonepileptic Seizures. A controversial condition, Paroxysmal Startle Disorder, one major manifestation of this Paroxysmal Somatoform Disorder is postulated not only to exist, but argued to demonstrate an important biological mechanism for Paroxysmal Somatoform Disorder. Finally, a new name is suggested, namely Paroxysmal Photosensitive Disorder. The criteria for this condition are broadened as it not only may manifest in frank seizure phenomena, but alternatively in behavioral, cognitive and affective phenomena that may be subtle, or in significant headaches, like migraines. These new categorizations of paroxysmal disorders create a better way of conceiving of these episodic conditions but remain controversial because they involve new ways of seeing old phenomena.