Research Article| Volume 4, ISSUE 3, P531-548, August 1986


  • Michael R. Trimble
    Corresponding author: The National Hospital for Nervous Diseases, Queen Square, London WC1N 3BG, England
    Consultant Physician in Psychological Medicine and Senior Lecturer in Behavioral Neurology, The National Hospital for Nervous Diseases and The Institute of Neurology, London, England
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      The history of hysteria, with special reference to pseudoseizures, is reviewed. The distinguishing features between nonepileptic and epileptic convulsions are then considered, prior to discussion of management and prognosis. The various psychopathologies associated with the diagnosis are noted, as are psychiatric conditions that may be confused with epilepsy. It is concluded that pseudoseizures represent a complex clinical problem, often requiring multidisciplinary evaluation, that can be rewarding to diagnose and treat.
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        • Abbott R.J.
        • Browning M.C.K.
        • Davidson D.L.W.
        Serum prolactin and cortisol concentrations after grand mal seizures.
        J. Neurol. Neurosurg. Psychiatry. 1980; 43: 163-167
      1. American Psychiatric Association: D.S.M.-III. Washington D. C., 1980.

        • Berkovic S.
        Clinical and Experimental Aspects of Complex Partial Seizures. Doctor of Medicine Thesis. University of Melbourne, 1984
      2. Cheyne, G.: The English Malady. London, 1733.

        • Chodoff T.
        • Lyons H.
        Hysteria, hysterical personality and hysterical conversion.
        Am. J. Psychiatry. 1958; 114: 734-740
        • Collins W.C.J.
        • Lanigan O.
        • Callaghan N.
        Plasma concentrations following epileptic and pseudoseizures.
        J. Neurol. Neurosurg. Psychiatry. 1983; 46: 506-508
        • Dana-Haeri J.
        • Trimble M.R.
        • Oxley J.
        Prolactin and gonadotrophin changes following generalized and partial seizures.
        J. Neurol. Neurosurg. Psychiatry. 1983; 46: 331-335
        • Desai B.T.
        • Porter R.J.
        • Penry J.K.
        Psychogenic seizures.
        Arch. Neurol. 1982; 39: 202-209
        • Feldman R.G.
        • Paul N.L.
        • Cummins-Ducharme J.
        Video tape recording in epilepsy and pseudoseizures.
        in: Riley T.L. Roy A. Pseudoseizures. Williams and Wilkins, Baltimore1982: 122-134
        • Fenton G.W.
        Hysterical alterations of consciousness.
        in: Roy A. Hysteria. J. Wiley and Sons, Chichester1982: 229-246
        • Fenwick P.
        Precipitation and inhibition of seizures.
        in: Reynolds E.H. Trimble M.R. Epilepsy and Psychiatry. Edinburgh, Churchill Livingstone1981: 306-321
        • Fenwick P.
        Aggression and epilepsy.
        in: Trimble M.R. Bolwig T. Psychiatric Aspects of Epilepsy. J. Wiley and Sons, Chichester1986 (in press)
        • Gadd R.A.
        • Merskey H.
        Middlesex Hospital questionnaire scores in patients with hysterical conversion symptoms.
        Br. J. Med. Psychol. 1975; 48: 367-370
        • Gallagher B.B.
        • Murvin A.J.
        • King D.W.
        • et al.
        ACTH and prolactin secretion in man during electrical stimulation of medical temporal lobe structures.
        Neurology. 1984; 34 (Suppl.): 125
        • Gowers W.R.
        Epilepsy. J. A. Churchill, London1881
        • Guze S.D.
        • Perley M.J.
        Observations on the natural history of hysteria.
        Am. J. Psychiatry. 1953; 119: 960-965
        • Harper M.
        • Roth M.
        Temporal lobe epilepsy and the phobic anxiety-depersonali zation syndrome.
        Compr. Psychiatry. 1962; 3 (and 215-226): 129-151
        • Henry J.
        • Woodruff G.A.J.
        A diagnostic sign in states of apparent unconsciousness.
        Lancet. 1978; 2: 920-921
        • Hoppener R.J.E.A.
        • Rentmeester T.H.
        • Arnoldkssen W.
        • et al.
        Changes in serum prolactin levels following partial and generalized seizures.
        Br. J. Clin. Pract. 1982; 18: 193-195
        • Holmes G.L.
        • Sackellares J.C.
        • McKiernan J.
        • et al.
        Evaluation of childhood pseudoseizures using EEG telemetry and video tape monitoring.
        J. Paediatr. 1980; 97: 554-558
        • Jeavons P.M.
        Choice of drug therapy in epilepsy.
        Practitioner. 1977; 219: 542-546
        • Jellife S.E.
        • White W.A.
        Diseases of the Nervous System. Lewis, London1929
        • King D.W.
        • Gallagher D.B.
        • Murvin A.J.
        • et al.
        Pseudoseizures: Diagnostic evaluation.
        Neurology. 1982; 32: 18-23
        • Krapf E.C.
        On the pathogenesis of epileptic and hysterical seizures.
        Bull. World Health Org. 1957; 16: 749-762
        • Krumholz A.
        • Niedermeyer E.
        Psychogenic seizures: A clinical study with follow up data.
        Neurology. 1983; 33: 498-502
        • Laxer K.D.
        • Mulloly J.P.
        • Howell B.
        Prolactin changes after seizures classified by EEG monitoring.
        Neurology. 1985; 35: 31-35
        • Lesser R.P.
        Psychogenic seizures.
        in: Pedley T. Meldrum B.S. Recent Advances in Epilepsy. Churchill Livingston, Edinburgh1985: 273-296 (Vol. 2.)
        • Ljungberg L.
        Acta Psychiatr. Scand. 1957; 112
        • Luther J.S.
        • McNamara J.O.
        • Carwile S.
        • et al.
        Pseudoepileptic seizures: Methods of video-analysis to aid diagnosis.
        Ann. Neurol. 1982; 12: 458-462
        • Mark V.H.
        • Ervin E.R.
        Violence and the Brain. Harper & Row, London1970
        • Merskey H.
        • Burhich N.A.
        Hysteria and organic brain disease.
        Br. J. Med. Psychol. 1975; 48: 359-366
        • Merskey H.
        • Trimble M.R.
        Personality, sexual adjustment, and brain lesions in patients with conversion symptoms.
        Am. J. Psychiatry. 1979; 136: 179-182
        • Oxley J.
        • Roberts M.
        • Dana-Haeri J.
        • et al.
        Evaluation of prolonged 4-channel EEG tape recordings and serum prolactin levels in the diagnosis of epileptic and nonepileptic seizures.
        in: Dam M. Gram L. Penry J.K. Advances in Epileptology. Raven Press, New York1981: 343-357
        • Pierce-Clark L.
        The psychobiological concept of essential epilepsy.
        J. Nerv. Ment. Dis. 1923; 57: 433-444
        • Pritchard P.B.
        • Wannamaker J.
        • Sagel J.
        • et al.
        Endocrine function following complex partial seizures.
        Ann. Neurol. 1983; 14: 27-32
        • Purtell J.J.
        • Robins E.
        • Cohen M.E.
        Observation on clinical aspects of hysteria.
        J.A.M.A. 1951; 146: 902-910
        • Ramani S.V.
        • Quesney L.F.
        • Olson D.
        • et al.
        Diagnosis of hysterical seizures in epileptic patients.
        Am. J. Psychiatry. 1980; 137: 705-709
        • Reed J.L.
        in: Silverstone T. Barraclough B. Contemporary Psychiatry. Headley Bros., England1975 (British Journal of Psychiatry, Special Publication, No. 9. Kent)
        • Robertson M.M.
        • Trimble M.R.
        Depression and epilepsy: A review.
        Br. J. Clin. Pract. 1982; 18: 48-51
        • Roy A.
        Hysterical fits previously diagnosed as epilepsy.
        Psychol. Med. 1977; 7: 271-273
        • Roy A.
        Hysterical seizures.
        Arch. Neurol. 1979; 36: 447
        • Roy A.
        Management of hysterical seizures.
        in: Riley P.L. Roy A. Pseudoseizures. Williams and Wilkins, Baltimore1982: 159-168
        • Slater E.
        Diagnosis of hysteria.
        Br. Med. J. 1965; 1: 1395-1399
        • Stefanis C
        • Markidis M.
        • Christodoulou C
        Observations on the evolution of hysterical symptomatology.
        Br. J. Psychiatr. 1976; 128: 269-275
        • Stewart R.S.
        • Lovitt R.
        • Stewart R.M.
        Are hysterical seizures more than hysteria? Am.
        J. Psychiatr. 1982; 139: 926-928
        • Tempkin O.
        The Falling Sickness. Johns Hopkins Press, Baltimore1945
        • Thompson P.
        • Trimble M.R.
        Anticonvulsant drugs, cognitive function and behavior.
        Epilepsia. 1982; 24: 21-22
        • Trimble M.R.
        Serum prolactin in epilepsy and hysteria.
        Br. Med. J. 1978; 2: 1682-1978
        • Trimble M.R.
        Neuropsychiatry. England J. Wiley and Sons, Chicester1981
        • Trimble M.R.
        Post-Traumatic Necrosis. J. Wiley and Sons, Chichester, England1981
        • Trimble M.R.
        • Dana-Haeri J.
        • Oxley J.
        • et al.
        Some neuroendocrine consequences of seizures.
        in: Porter R. Advances in Epileptology. 15th EI Symposium. Raven Press, New York1985: 201-208
        • Wayne Massey E.
        History of Epilepsy and Hysteria.
        in: Riley T.L. Roy A. Pseudoseizures. Williams and Wilkins, Baltimore1982: 1-20
        • Willis T.
        An Essay on the Pathology of the Brain and Nervous Stock in which Convulsive Diseases are Treated. Leigh, Harper, Dring, 1684 (Pordage, S. (Trans.))
        • Williams D.T.
        • Gold A.P.
        • Shrout P.
        • et al.
        The impact on psychiatric intervention on patients with uncontrolled seizures.
        J. Nerv. Ment. Dis. 1979; 167: 626-631
        • Wilson-Barnett J.
        • Trimble M.R.
        An investigation of hysteria using the illness behaviour questionnaire.
        Br. J. Psychiatr. 1985; 146: 601-608
        • Wyllie E.
        • Luders E.
        • MacMillan J.P.
        • et al.
        Serum prolactin levels after epileptic seizures.
        Neurolog. 1984; 34: 1601-1604