Treatment of patients with coexisting epileptic and nonepileptic seizures.

A majority of studies have reported a rate of concurrence of epileptic seizures (ESs) in patients with nonepileptic seizures (NESs) of about 10-18%. We explored the relationship between the two paroxysmal disorders (ESs and NESs) in a series of patients with both, and report a treatment for these patients that proved remarkably effective: reduction of the dose of antiepileptic drug to the minimum required to achieve optimal freedom from seizures. NESs are hypothesized to have a psychobiological basis, and it has been proposed that they be recognized as posttraumatic startle seizures. Excessive suppression of epileptic paroxysmal activity appears to favor the expression of posttraumatic paroxysmal activity in patients with both paroxysmal disorders, and the manifestation of ESs and NESs tends to alternate. Of etiological significance is the finding that the patients commonly have both a personal history of trauma and a family history of epilepsy.