The diagnostic significance of video-EEG monitoring findings on pseudoseizure patients differs between neurologists and psychiatrists

Abstract

Purpose: The diagnosis of psychogenic pseudoseizures has improved with the availability of video-electroencephalography (EEG) monitoring; however, the outcome of this difficult disorder has remained poor. In an attempt to elucidate factors contributing to this poor outcome, we hypothesized that neurologists and psychiatrists differ in their views of the diagnosis and management of psychogenic pseudoseizure patients. Methods: The hypothesis was tested by using a brief anonymous questionnaire administered to neurologists and psychiatrists at continuing medical education (CME) conferences. Results: We found that neurologists and psychiatrists differ significantly in their opinion as to the accuracy of the video-EEG procedure; psychiatrists view video-EEG as often inaccurate in the diagnosis of psychogenic pseudoseizures compared with neurologists (p < 0.001). Neurologists, more frequently than psychiatrists, thought that patients' own psychopathology rather than "doctors dropping the ball" was a predominant factor in contributing to therapeutic failure, but this difference between specialties did not reach statistical significance. Conclusions: Resolving the differences between neurologists and psychiatrists would be helpful in caring for psychogenic pseudoseizure patients. These results support the need to encourage psychiatrists to have an integral involvement in epilepsy centers and to improve the understanding of psychogenic pseudoseizures in both disciplines.