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Research on the subjective experience of dissociative (psychogenic non-epileptic) seizures (DS) is dominated by that on objective semiology.1 ,2 Patients with DS tend not to spontaneously volunteer any warning symptoms, nor feelings of resistance to seizure onset, both of which are more common in epilepsy.3 But when an ‘aura’ is sought, studies in DS have found rates of 25–60%,4–7 typically with somatic symptoms of autonomic arousal such as dizziness, depersonalisation and chest tightness along with cognitive symptoms such as fear of losing control. This cluster of symptoms may sometimes meet criteria for a panic attack or an episode of hyperventilation, but in many cases, does not. This suggests that patients with DS do have prodromal symptoms but generally don't want to talk about them. Goldstein and Mellers6 proposed that DS are a “paroxysmal, dissociative response to heightened arousal in the absence of raised general anxiety levels”.
As we explored this ‘dissociative response’ in more detail with patients, we met some who were willing to admit that the attack was, at times, a welcome relief from their unbearable prodromal symptoms. This led us to discover that a number of our patients were aware of exerting conscious control over the onset of their blackouts.
Between August 2010 to …
Contributors JS and AC both conceived the study, contributed data, drafted and revised the manuscript.
Competing interests None.
Ethics approval Audit of our routine practice to describe new observation.
Provenance and peer review Not commissioned; externally peer reviewed.