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Convulsive Nonepileptic



Don W. King, MD

— convulsion is defined as "an invol-i\ untary contraction or series of i 1 contractions of the voluntary mus. cles" (1). Convulsive epileptic seizures refer to epileptic seizures that are characterized by vigorous muscle contractions. Using this definition, convulsive epileptic seizures may include generalized tonic-clonic (GTC) seizures, generalized tonic seizures, generalized myoclonic seizures, and partial seizures in which there is prominent tonic or clonic activity.

In this chapter, convulsive nonepileptic events refer to nonepileptic events that have vigorous motor activity and thus may be confused with convulsive epileptic seizures. It is often difficult to differentiate convulsive nonepileptic events from convulsive epileptic events, and it is common for patients with convulsive nonepileptic events to be diagnosed with epilepsy. Many of these patients are treated with antiepileptic agents for years, and some may be referred for evaluation for epilepsy surgery. Because an accurate diagnosis is essential for the appropriate management of these patients, a vigorous effort should be made to establish a correct diagnosis.

To allow comparison of convulsive nonepileptic events with convulsive epileptic events, this chapter begins with the description of a patient who had GTC

seizures. The case description is followed by a brief discussion of the phenomena of GTC seizures and of a recent study concerning the mechanism of epileptic clonic activity. The next two sections consist of case descriptions and discussions of the two most common types of events that mimic convulsive epileptic seizures—convulsive syncope and psychogenic seizures or pseudoseizures. These discussions include the clinical features, mechanism, etiology, work-up, and management of these events. The behavioral phenomena of each type of event and its differentiation from an epileptic seizure are emphasized.

The final three sections discuss three other types of events that may result in vigorous motor activity and thus may mimic convulsive epileptic seizures. These include paroxysmal dyskinesia, periodic limb movements of sleep (PLMS), and REM sleep behavior disorder (RBD). Each patient described in this chapter underwent monitoring in the Medical College of Georgia (MCG) Epilepsy Monitoring Unit.

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