The effective and ethical use of voluntary induction of psychogenic drop attacks in a patient with idiopathic generalized epilepsy.

A woman known to have never fully controlled idiopathic generalized epilepsy presented at 47 years of age with a new onset of drop attacks. After clinical investigations, including prolonged video/EEG telemetry, tilt-table testing, and multiple sleep latency tests, the etiology of her drop attacks remained elusive. Subsequently we were able to demonstrate that her drop attacks may be provoked by her voluntary recollection of memories of past sexual abuse. This case study highlights the need to consider psychological factors when evaluating otherwise unexplained drop attacks. In addition, we propose a seizure-provoking technique that may be used both effectively and ethically in the diagnosis of psychogenic drop attacks as well as nonepileptic seizures. Copyright (c) 2010 Elsevier Inc. All rights reserved.