8. Non-epileptic seizures: diagnosis and treatment

Non-epileptic seizures are difficult to diagnose and hard to treat. In this episode, we delve into the specifics of this disorder and discuss the obstacles to effective treatment. We are joined by the wonderful Dr. Laura Strom, an epileptologist at the University of Colorado who specializes in the treatment of patients with non-epileptic seizures. She went to medical school at Penn State University College of Medicine and completed her neurology residency and epilepsy fellowship at the University of Colorado. She is the head of the non-epileptic seizure clinic at the University of Colorado and is the primary investigator in an ongoing study for patients with non-epileptic seizures. Her clinic provides comprehensive neurologic and psychiatric treatment to patients with non-epileptic seizures and has treated more than 600 patients as of 2020.

For this episode, I was assisted by my first ever co-host, Jamie Moffa. Jamie is an MD PhD candidate at Washington University with an interest in the intersection between neurology and psychiatry. 

Time stamps:

• 3:49 Why neurology
• 6:28 Why functional neurological disorders?
• 9:17 How did you learn to treat patients with non-epileptic seizures?
• 14:20 Non-medical book recommendation?
• 15:45 Patient case of non-epileptic seizures (NES)
• 18:04 What should you call this disorder?
• 19:50 What are non-epileptic seizures?
• 22:25 Clinical symptoms that help distinguish between NES and epileptic seizures
• 23:45 Functional MRI in non-epileptic seizures
• 26:30 What elements of the history suggest NES?
• 29:45 Medical co-morbidities associated with NES
• 31:30 How to discuss a diagnosis of NES
• 37:10 Common misconceptions about NES
• 39:02 Treatment for NES
• 40:45 Group therapy for NES
• 45:05 Larger applicability of group therapy model
• 48:27 How do you talk with resistant patients about psychological treatment?
• 52:40 How do you help patients who can't get access to mental health resources?
• 55:10 What is the role of neurologists in the care of NES patients?
• 58:45 Insurance coverage for patients with NES
• 1:01:40 Other obstacles to treatment for patients
• 1:06:45 Patient success story

Disclosures:

Dr. Strom report no relevant financial disclosures. Brain Boy Neurology reports no relevant financial disclosures.

Links:

Neuroimaging in non-epileptic seizures:

https://academic.oup.com/brain/advance-article/doi/10.1093/brain/awab131/6179314

Clinical calculator to determine likelihood of non-epileptic (dissociative) seizures:

https://wesleykerr.shinyapps.io/Combined/?_ga=2.119397517.543235477.1603997676-716097154.1580437477