Conversation analysis in the differential diagnosis of Italian patients with epileptic or psychogenic non-epileptic seizures: a blind prospective study.

The differential diagnosis of epileptic seizures (ES) and psychogenic non-epileptic seizures (PNES) is often difficult. The diagnostic gold standard is video-EEG, but this procedure is limited because of its high cost and is not always available. Research groups from Germany and Britain have used conversation analysis (CA) of patients' descriptions of their seizures as a means of differentiating the type of seizure. The aim of this study was to verify the value of their considerations in relation to the Italian language. Ten subjects (five with ES and five with PNES) diagnosed by means of the video-EEG recording of one seizure were studied under blind conditions by a linguist. The patients with ES described their seizures in as much detail as possible and tried to reconstruct the experience as fully as they can, making an effort to describe their subjective symptoms, quantify the duration of the phases preceding and following the seizure, and use the image of an external entity overcoming them. On the contrary, the patients with PNES repeated their extraneousness to the events that occur, refused to reply, expressed amnesia, reconstructed the happening by referring to descriptions provided by witnesses, and often describe their seizures using the image of an internal entity of which they were victims. The linguist correctly identified nine cases out of ten using CA.