pseudorelapse of multiple sclerosis
(sood″ō-rē′laps″) [pseudo- + relapse] Neurological deterioration in a patient with multiple sclerosis caused by a new medication, an infection, or another disease rather than by new demyelination in the central nervous system. The signs and symptoms of pseudorelapse improve when the patient’s new medication is eliminated or the underlying disorder is treated.
(sood″ō-sē′zhŭr) [pseudo-+ seizure] A series of movements, sensations, or behaviors that resemble a seizure but are not caused by abnormal electrical brain activity. The condition is the most common of the conversion disorders. SYN: nonepileptic attack disorder; psychogenic nonepileptic seizure.
INCIDENCE: Although nonepileptic seizures (NES) are rare in the population at large (less than 5 per 100,000 people), epilepsy specialists estimate that between 20% and 30% of patients referred to them for diagnosis or management have psychogenic NES rather than epilepsy.
CAUSES: Many patients with nonepileptic seizures were abused as children or have suffered significant trauma. Depression, anxiety, and other mental disorders are more common in people with NES than in the population at large.
SYMPTOMS AND SIGNS: Muscle jerking resembling tonic-clonic seizures, often with apparent loss of consciousness and other seizure-like activities, are common symptoms. The symptoms and signs of a nonepileptic seizure often occur when the patient is experiencing significant stress.
DIAGNOSIS: The diagnosis is clinically challenging. Patients are typically seen for an average of 7 years before the diagnosis is established. In very young children, esp. those under the age of 5, sleep disorders and behavioral disorders (such as temper tantrums) are common mimics of seizure. Some specialists have used blood tests for neuron-specific enolase, creatine kinase, or prolactin levels to distinguish epileptic seizures from pseudoseizures, but these tests have not proved to be reliable diagnostic markers. Personality tests are difficult to interpret. The optimal test (simultaneous video recording during electroencephalography) requires admission to specialized seizure centers, but the interpretation of video-EEG is not always clear and may be subtle or require consensus.
TREATMENT: Anticonvulsant medications are more likely to harm patients than to treat the disorder and are contraindicated. Cognitive behavioral therapy and supportive psychotherapies help some patients live seizure-free.
IMPACT ON HEALTH: Psychogenic seizures resolve in about 50% of patients over time, but they are more likely to be refractory to treatment than epileptic seizures.
PATIENT CARE: Most epileptologists recommend a nonjudgmental attitude toward patients with psychogenic NES: establishing rapport is essential to the appropriate treatment of the patient; advising the patient of the diagnosis is also a critical element of care.
(soo-dō-străt′ĭ-fīd) [″ + L. stratificare, to arrange in layers] Apparently composed of layers.