Hypnotic Recall: A Positive Criterion in the Differential Diagnosis Between Epileptic and Pseudoepileptic Seizures

Department of Psychiatry, VU University Amsterdam, Amsterdamo, North Holland, Netherlands
Epilepsia (Impact Factor: 4.57). 05/1999; 40(4):485-91. DOI: 10.1111/j.1528-1157.1999.tb00745.x
Source: PubMed


Because the diagnosis of pseudoepileptic seizures (PESs) is mostly made by excluding epilepsy, availability of a positive criterion for PESs is of great importance. This study was aimed at the validation of a diagnostic technique that intends to provide in such a positive criterion.
In 17 patients with epileptic seizures (ESs) and 20 patients with PESs, a hypnotic procedure was performed by an investigator blind to other data to recover amnesia for the ictus. If recall was obtained, the experimental diagnosis PES was given; if not, ES was diagnosed. The experimental diagnoses were compared with the clinical, EEG-confirmed diagnoses. Hypnotizability was measured to determine the relation between the outcome of the test and hypnotizability of the patients.
Recall for the ictus was obtained in 17 patients. Each of these had a clinical diagnosis of PES. Seventeen patients with "no recall" had a clinical diagnosis of ES, and three patients had PESs. This result yields a specificity of 100% and a sensitivity of 85% for the recall technique. Hypnotizability was significantly higher in patients with PESs than in patients with ESs. In some "low hypnotizables," recall was obtained, and in some "high hypnotizables," no recall was obtained.
A positive recall test indicates PES. A sub-group of patients with PESs is characterized by a high level of hypnotizability. Hypnotizability is not crucial for outcome of the recall test. High hypnotic abilities are especially found in disorders in which it is supposed that "dissociation" is involved. It can be speculated that PES may be one of the dissociative phenomena.

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Available from: Philip Spinhoven, Dec 30, 2014
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    • "Some studies have reported higher rates of hypnotizability in patients with conversion disorders as compared to controls or patients with other pathological states (e.g. affective disorders) [6] [35] [53], while others have shown no difference in both hypnotizability and absorption (defined as the tendency to become fully involved in a perceptual, imaginative , or ideational experience) between patients with conversion disorders and controls [37]. A last study showed higher level of absorption in control subjects as compared to patients [23]. "
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    • "Other approaches have used hypnosis to reverse amnesia for the seizure itself, which would not be expected after an epileptic seizure; Kuyk et al. (1999) demonstrated that the hypnotic recall technique yielded a specificity of 100% and sensitivity of 85% for PNES diagnoses. Studies have also indicated that patients with PNES score more highly than patients with epilepsy on measures of hypnotizability such as the Hypnotic Induction Profile (Kuyk et al., 1999; Barry et al., 2000; Khan et al., 2009), and these measures may be a useful adjunct, although their own sensitivity/specificity in the diagnostic procedure is less clear. "
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    ABSTRACT: An international consensus group of clinician-researchers in epilepsy, neurology, neuropsychology, and neuropsychiatry collaborated with the aim of developing clear guidance on standards for the diagnosis of psychogenic nonepileptic seizures (PNES). Because the gold standard of video electroencephalography (vEEG) is not available worldwide, or for every patient, the group delineated a staged approach to PNES diagnosis. Using a consensus review of the literature, this group evaluated key diagnostic approaches. These included: history, EEG, ambulatory EEG, vEEG/monitoring, neurophysiologic, neurohumoral, neuroimaging, neuropsychological testing, hypnosis, and conversation analysis. Levels of diagnostic certainty were developed including possible, probable, clinically established, and documented diagnosis, based on the availability of history, witnessed event, and investigations, including vEEG. The aim and hope of this report is to provide greater clarity about the process and certainty of the diagnosis of PNES, with the intent to improve the care for people with epilepsy and nonepileptic seizures.
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    • "A number of other interventions have been studied either only in single case studies, small group studies, or in studies where the main patient group had other (especially motor) conversion disorders. Therefore, for example , although hypnosis has been tested as a diagnostic tool for PNES, with varying levels of sensitivity and specificity when PNES patients are compared to people with epilepsy (Kuyk et al., 1995, 1999; Barry et al., 2000; Khan et al., 2009), and studies have also shown that patients with PNES obtain higher scores than patients with epilepsy on measures of hypnotizability (Kuyk et al., 1999; Barry et al., 2000; Khan et al., 2009), thereby raising expectations of the potential utility of hypnosis as a therapeutic tool for PNES, little explicit use has been made of hypnosis in the treatment of PNES, and there is no robust evidence to recommend its use as a primary intervention for PNES, even when administered by an experienced hypnotherapist . However, a number of single case reports of its use as an adjunctive therapy can be found (e.g., Stonnington et al., 2006). "
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