Table 1

Clinical features, prodromal symptoms cognitions and outcome in patients with dissociative (psychogenic non-epileptic) seizures

Prodromal symptoms
Age/sexType of attackDuration*DiagnosisMain comorbiditiesSomatic symptomsCognitionsWilful submissionOutcome
17FSudden motionless unresponsiveness, 60–120 s8 months, 1–2× dayClinician witnessed attacksAnxietyRising sensory disturbance, chest tightness, breathlessness, palpitations‘There but not there’, ‘Horrible’‘Just want the attack to happen to get rid of the feeling’Attack free for 2 years, with minor recurrence, working
17FMotionless unresponsive episodes evolving to four limbs jerking, arching and self-slapping-preserved awareness on occasions. 60–600 s10 months, up ×20 dayClinician witnessed attacksLow moodTaste in mouth, fluttering in abdomen, arms and legs go heavy, band-like sensation round headProdrome very unpleasant . ‘I know its going to happen’Can dissociate at will. Did so at clinic to demonstrate (with left arm jerking). Despite this was upset at psychological formulation as thought that equated with ‘making it up’Attack free for 4 months, return to normal school activities.
21FFalls to ground, lies in flexed posture then a pause followed by leg and arm jerking. 60–300 s,10 years, approx 1× weekEEG confirmedAnxiety, low mood, irritability, intermittent self-harm.Occasional ‘vision closing in’Becomes unusually irritable and ‘disliking almost everyone’. Prodrome highly unpleasant.Acknowledged that can prevent seizures but sometimes brings them on deliberately as it is ‘easier’.Significantly improved but with intermittent seizures. Trying to return to college.
24FGeneralised twitching, falls, unaware, 5–60 min12 months, 0–5× dayClinical Diagnosis—able to avert attacksComplex regional pain syndromeIncreasing pain from CRPS<AQ: Please provide full form of CRPS>, hot, sweaty, funny taste‘Not there’, ‘Pain unbearable’‘Its like your body wants to do it to make the pain better’Attacks continue, not working
29FMotionless unresponsiveness, eyes roll, 60–600 s24 months, 3–4× monthClinical diagnosis—able to avert attacksAnxietyChest heaviness, heat, headache, tingling right arm‘Not there’ ‘out of it’, shouts ‘its coming’ but can't remember doing so.I don't have the energy to fight the attack—just want it to hurry up and come alongAttacks reduced and confined to evenings, working
30FMotionless unresponsiveness, 30 s14 months, 3–4× monthClinical diagnosis—able to avert attacksAnxiety, globusPalpitations,‘Not there’‘Feel like I want it to happen so the feeling goes away’Attacks largely gone, working
30FGeneralised shaking retained awareness, falls 60–600 s6 months, 2–3× dayClinical diagnosisPain, fatigueGrinding sensation in teeth and chest as if being pulled underwater‘Frightening’, ‘Horrible’Doesn't feel well until she allows herself to ‘go through it’. Like trying to hold poisonous gas in her mouthAttacks continue unchanged, not working
32FGeneralised shaking, falls, sometimes with preserved awareness, 180–240 s3 months, ∼10×/monthClinical diagnosis—retained awarenessTremor, weakness, fatigueQueasy, ‘as if I have spun round,’ arms shaking, sweaty hot, ‘breathing goes funny’‘Horrible’, ‘frightened’ feeling escalating over 180–240 sWishes that she would blackout to get rid of the feelingAttacks ceased following consultation, not working
36MLoses consciousness, jerking, 120–900 s4 years, 0–20 weekEEG confirmedAnxiety, fatigue, widespread joint and muscle pain.Initially denied but later admitted to cardiorespiratory somatic of panic and said they were highly unpleasantIncreasing sense of irritability. ‘highly unpleasant’Averted two seizures at prodromal stage l but effortful and exhausting Acknowledged in past he had brought seizures on in these circumstancesImproved, no seizures in over 2 months but frequent anxiety attacks. Beginning to return to some normal function
39FBilateral limb shaking, eyes roll backwards, protruding tongue, can't speak, preserved awareness, duration minutes to 1 h18 months, 1–2/weekClinical diagnosis—retained awarenessPhobic anxiety, hyperventilationMalaise, shaking in left leg then right legAnxious cognitions that if prodrome was prolonged that she may damage herself and ‘never come out of it’Acknowledged that she brought on seizures as she was anxious about long term damage (signalled by prodrome symptoms) if she did notWith explanation that the attack is not physiologically harmful- has diminished intensity attacks presenting more like typical panic
54FGoes blank, arms and legs jerk, unaware, doesn't fall 30–60 s30 months, 1–2× dayEEG confirmedDepression, pain, anxiety, bladder symptomsNone‘Horrible’ ‘frightening’; ‘Out of control’ ‘not there’. ‘there is nothing I can do’. Traumatic memory, 10 sLater admitted tearfully that once the prodromal symptoms start she wants the attack to happen to take them awayAttacks continue unchanged, working
  • *Duration of attacks from onset to discovery of wilful submission.

  • F, female; M, male.