144 Brain tumour related epilepsy with co-existing non epileptic attacks: characteristics of a clinically challenging cohort

Background

The co-existence of non epileptic attacks (NEAD) in patients with brain tumour related epilepsy (BTRE) is poorly described. Non epileptic attacks (NEAD) co-occur in up to 30% of patients with epilepsy (PWE) [SS1] . Adverse life events are associated with development of NEAD; their co-occurrence in those with BTRE is potentially un-surprising .

Methods

Clinical trajectories of patients with BTRE and co-existing NEAD were characterised. The diagnosis of NEAD was based on specialist’s observation of attacks and/or capture of attacks on video. Patients had been referred because of persisting symptoms in spite of escalating antiepileptic therapy.

Results

Of seven patients, six developed NEAD following development of BTRE. One developed NEAD de novo following tumour biopsy. Onset of NEAD was not temporally linked with the diagnosis of a brain tumour. In five, NEAD onset occurred when seizures were controlled (< 1 seizure/month). All seven nev- ertheless reported fear of developing uncontrolled seizures and identified their NEAD as more disabling than their epilepsy.

Six were initially misdiagnosed with escalating seizures. Patients were eventually managed with polytherapy (two found adjunctive clobazam helpful) and behavourial strategies including mindfulness.

Conclusion

NEAD can co-occur with BTRE and should be considered where seizure type symptoms are escalating.

[SS1]S.R. Benbadis, W.A. HauserAn estimate of the prevalence of psychogenic non-epileptic seizures.

Seizure, 9 (2000), pp. 280–281 shani@doctors.org.uk