The attention-emotion relationship in patients with psychogenic non-epileptic seizures: a pilot study

5 CHAPTER 1 : PSYCHOGENIC NON-EPILEPTIC SEIZURES 1. Introduction 1.1. Definition According to the recent literature, a psychogenic non-epileptic seizure (PNES) can be defined as an observable abrupt paroxysmal change in behaviour and consciousness (sometimes also defined as an episode of altered movement, sensation, experience or internal psychic state) that resembles an epileptic seizure but is characterized by the absence of typical electrophysiological changes that accompany an epileptic seizure and for which no evidence is found for other somatic causes; there is instead a positive evidence or a strong suspicion for psychogenic factors that may have caused the seizure (Bodde et al., 2009). Current theories explain this illness invoking a psychosocial etiology, but the conceptual and etiological understanding of PNES has changed over the centuries. Historically, seizures in general were understood to carry religious, spiritual, and even mythological meanings. Ancient populations, like the Egyptians, the Greeks, the Romans and the Navajo, traced an association with sexual abuse (Sharpe & Faye, 2006), whereas during the middle ages and the witch hunt in Europe, seizures and convulsions were treated as a sign of demonic possession. Between the 18 th and the 20 th century several clinics tried to understand the etiology and the principal characteristics of psychogenic non-epileptic seizures (Dickinson & Looper, 2012): in the late 18 th century Franz Mesmer (1734 – 1815) used his theory of the flow of magnetic fluid in all living beings to explain, induce and cure seizures; at the end of the 19 th century Jean-Martin Charcot (1825 – 1893) was the first to describe hysteria as an organic clinical disorder and classified PNES as “hysteroepilepsy” , an organic disorder of the brain. Nevertheless, he continued to use the same treatments that mesmerists and exorcists used centuries earlier, like hypnosis and seizure induction