Seizures in Vets Often Misdiagnosed

Sept. 6, 2011 -- Seizures or attacks caused by psychological issues may be especially difficult to diagnose in veterans, according to a new study.

Researchers found veterans with these seizures, called psychogenic or non-epileptic seizures, often wait many years longer than civilians for proper diagnosis and treatment.

Unlike epileptic seizures, which are caused by a neurological disorder, psychogenic seizures are caused by psychological issues.

Veterans with psychogenic seizures were often four times more likely than civilians to be given seizure medications designed to treat epilepsy until a correct diagnosis was made.

“People with psychogenic seizures are often diagnosed with epilepsy and given drugs to treat epilepsy that do not help and can have serious side effects,” researcher Martin Salinsky, MD, of the Portland VA Medical Center and Oregon Health and Sciences University, says in a news release. “The two types of seizures can be similar in appearance and diagnosis can be difficult.”

Diagnosis Delayed for Veterans

In the study, published in Neurology, researchers reviewed the medical records of 203 veterans and 726 civilians who were admitted to an epilepsy monitoring unit over a 10-year period. During this time, 50 veterans were diagnosed with psychogenic seizures.

Researchers matched these 50 veterans with 50 civilians with the same diagnosis.

In comparing their records, the researchers found it took an average of five years from the time symptoms began for veterans to be diagnosed with non-epileptic seizures, compared with about one year for the same diagnosis in civilians.

Nearly 60% of the veterans were presumed to have seizures related to traumatic brain injury.

Researchers say one of the reasons for the delay in diagnosis might be the limited number of epilepsy monitoring units in VA medical centers.

Salinsky says another reason may be a tendency to accept a diagnosis of epilepsy in veterans because of their high rates of traumatic brain injury, which can often lead to epilepsy.

Seizures or Attacks?

In a related editorial published in the same journal, researchers say many health care providers struggle over what to call seizures caused by an underlying psychological problem: “seizures” or “attacks.”

“Many patients resist the diagnosis,” write researchers John Langfitt, PhD, and William Watson, PhD, of the University of Rochester School of Medicine. “They may have heard it before in ways that suggest that the events are ‘all in their head,’ or that they are ‘crazy’ or ‘faking it.’”

To lower the defensiveness and perceived stigma, researchers advise explaining that the symptoms are fairly common and simply another way that thoughts and feelings manifest physically.

“Examples we commonly cite include smiling at a friend, blushing when embarrassed, and nausea and palpitations before speaking in public,” they write. “All these are normal, involuntary physical responses to internal emotions. They are no more ‘all in the head’ or under conscious control than the patient’s symptoms.”