Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part I.

Three hundred and forty three patients with attack disorder labelled as epilepsy were admitted for assessment to a Neuropsychiatry ward in a small English mental hospital over a 5 year period. After assessment it was decided that 63% (215) of these patients had epilepsy, but in 128 (37%) a diagnosis of non-epileptic seizures was made. Just over a third of these patients (46) had an additional history of present or past epileptic seizures as well, so that 24% of the total population had non-epileptic seizures only. The methods used to make this diagnosis are reviewed and an attempt made to classify the non-epileptic attacks from which the patients were suffering. A variety of management strategies were offered and at discharge from hospital the majority of patients had practically lost their non-epileptic seizures. At follow-up 2 years later, seizures had returned in most patients. In 8% of the patients it was clear that the diagnosis of non-epilepsy had been erroneous. The importance of classifying the kind of non-epileptic event the patient suffers from and of translating treatment in hospital to the community is emphasized.