Talk:Non-epileptic seizure

Discussion

As stated in the initial sentence, non-epileptic seizures have a well defined and narrow definition that excludes neurological involvement. The use of the word "epileptic" does, however, give confusion with "epilepsy". A person can have an epileptic seizure, without having epilepsy – the word "epileptic" indicates the nature of the event (neurological) rather than implying a long-term underlying disease. Causes of such (usually one-off) seizures include injury, drugs, toxins and febrile convulsions.

I've reverted the edit of 00:13, 29 May 2006 (UTC) since it appeared to be expanding the definition to mean "seizures in someone who does not have epilepsy". Whilst that category of seizures is worthy of discussion (in the seizure article), it is not what this article is about.

Colin°^Talk 16:47, 29 May 2006 (UTC)

I've taken the liberty of indenting and numbering the following post by Preacherdoc in order to make it easy for me to reply to the points -- Colin°^Talk 13:48, 30 May 2006 (UTC).

1. Colin, many thanks for your post. I disagree on several key points. I am not a neurologist, but am frequently involved in the care of people with epilepsy. I regret very much that you reverted my edit without posting this discussion first. The two main points are the title of the article, and the definition of the word "seizure".
2. You use the phrase: "a well defined and narrow definition that excludes neurological involvement". However, in my understanding, narcolepsy, tics, dyskinesia and parasomnia are all disorders of the central nervous system.
3. In my experience and opinion, the term "seizure" refers to that pattern of events which occurs due to abnormal and uncontrolled electrical activity in the brain. This may occur as part of epilepsy, or outwith it. (I agree with you that epilepsy is frequently misdiagnosed, and that not all types of seizure (including tonic-clonic events) denote epilepsy. The diagnosis of epilepsy is one which should be approached with considerable caution.)
4. I think the title "non-epileptic seizures" is confusing. When I read this phrase, to me it means "seizures which are not caused by epilepsy". It seems, however, that you mean "events which may resemble/ be mistaken for epileptic seizures"; this term to me seems inclusive of epileptiform seizures not caused by epilepsy. (I think the term "epileptiform" is useful).
5. The events which you describe here may indeed sometimes mimic epileptiform seizures, but I do not agree with you that they should be labelled as seizures. These include tics, myoclonus, narcolepsy, vasovagal syncope, migraine, and so on. I would not refer to any of these phenomena as "seizures", and believe that to so label them fudges the issue instead of clarifying it. You remark (in my talk pages): "I think that a lot of doctors find it hard to accept the use of the word "seizure" for something that isn't a "seizure" according to their understanding of the word." Indeed I do find it hard. I think it is misleading and unhelpful, and I do not concur that the (current) literature supports this use of the term.
6. If you intend this article to refer to those events which may be misdiagnosed as epilepsy, or which may mimic epileptiform events (and this is perfectly fine), then may I suggest that the title be changed to reflect that?
7. Hypoglycaemia may simply lead to loss of consciousness. When severe, it may indeed cause tonic-clonic events. Should this be included in your list?
8. Finally, the main seizure article seems to focus mainly on epilepsy; perhaps I can clear that up a bit. Thanks again.

Preacherdoc 06:01, 30 May 2006 (UTC)Preacherdoc.

Thanks for your comments. I appreciate your input and hope we can improve this and related articles as a result. I've tried to address each of your points below:

1. Your medical experience is extremely useful to Wikipedia, however one must be very careful not to edit articles from one's own understanding and beliefs. The official policy WP:VERIFY states:

Facts, viewpoints, theories, and arguments may only be included in articles if they have already been published by reliable and reputable sources.

I'm sorry if my revert has caused offence and can explain by way of a crude analogy (which I hope doesn't cause further offence): If someone had added a list of shrubs to the article on "trees", you wouldn't hang around debating the definition of "tree". You also wouldn't suggest the article was renamed "tall trees" because some people might get confused between trees and shrubs. It is not up to us (as Wikipedians) to make the definitions, or to come up with better phrases if the medical/scientific community have already defined them and use them.

2. You have a valid point and this definition needs rephrased. The initial sentence of the article does not contain my own definition. I have been careful to use a definition that is published in a reliable and reputable source (as per WP:VERIFY):

The book "Differential Diagnosis in Adult Neuropsychological Assessment" (ISBN 0826116655) has a section headed "Non-Epileptic Seizures" on p109. This says "Non-epileptic seizures are seizures that do not original from a primary neurological cause in the brain. The two types of non-epileptic seizures are physiological and psychogenic."

I suggest that the initial sentence be reworded to:

Non-epileptic seizures are paroxysmal events that mimic an epileptic seizure but do not involve abnormal, rhythmic discharges of cortical neurons.

This takes some words from the related Psychogenic non-epileptic seizures article, which was written by a neurologist specialising in epilepsy.

3. The difference between the medical and lay use of the word "seizure" is discussed in the article.

4. There is a problem with "to me it means" and "you mean". What Wikipedia must contain is what published, reputable, reliable sources define it to mean. Writing wikipedia articles requires a different mindset to writing an article for just about any other media. You may find the title confusing or even misleading, but it is a common term used by the medical community. As I said on your talk page, it is more of a category than a diagnosis.

The phrase "non-epileptic seizures" gets 42,100 Google hits, 100 Pubmed hits, 637 Google Scholar hits and is included in the title of several textbooks.

You say that to you "non-epileptic seizures" means "seizures which are not caused by epilepsy". Elsewhere it seems to me that you also think that "epileptic seizures" are only those seizures that are "caused by epilepsy". You go on to define "epileptiform seizures" as being "seizures which resemble those of epilepsy, without necessarily being caused by epilepsy". You also say "I think the term "epileptiform" is useful". These are all personal interpretations. However, Wikipedia must only contain interpretations that other people have published. Therefore, if you think your interpretations are commonly held, it would useful for you to provide some published evidence.

Epileptiform is defined:

Resembling epilepsy or its manifestations; may refer to a pattern on the EEG associated with an increased risk of seizures.

I have often seen it as an adjective when describing an EEG pattern. However, the phrase "epileptiform seizures" comparatively rare (140 PubMed hits vs 3,938 for "epileptic seizures", 13,000 Google hits vs 773,000). Your recent edit mentions this term twice, changing "epileptic" to "epileptiform" and giving the impression that it is a standard term, and somehow superior to "epileptic seizure". AFAIK, there is no difference between "epileptiform seizures" and "epileptic seizures" - merely perhaps a personal preference for one phrase over another.

I have a problem with the phrase: "seizures that are caused by epilepsy" (which you repeat on the seizure article) and that somehow the seizures are different if they are not "caused by epilepsy". I challenge you to identify a difference between a one-off tonic-clonic seizure and a tonic-clonic seizure in someone diagnosed with epilepsy. Both are epileptic seizures. The use of the word "resemble" here (and in seizure) implies that they are similar but different and perhaps even inferior. Epilepsy is an umbrella term for a condition caused by a variety of diseases and disorders and it would be wrong to think of it as a "cause". Clearly there are some idiopathic epilepsies (e.g. juvenile absence epilepsy) which have no other identified cause - you just have it - but in many cases of epilepsy there is a well defined cause such as a tumour, genetic disease or chronic brain injury.

5. The article does not label these as "seizures" - I was careful to use the phrase "paroxysmal events". The only place the word "seizures" occurs is as part of the title-phrase. The article also agrees with you that medical literature would never use the word "seizure" (on its own) to mean anything other than an epileptic seizure.

6. Whilst your argument against the title-phrase and its definition is perfectly valid (and one I sympathise with), it should be directed at the neurologists, researchers and authors who continue to use this term. You are not the only person who dislikes it (see the 2nd reference, and the section titled "Definitions and terminology".) That web-page is mainly concerned with psychogenic non-epileptic seizures and the author prefers the term "dissociative seizures", which also isn't widely used and also contains the word "seizure". In fact, the most widely used term is "pseudoseizures" - which almost everybody agrees is pejorative and should be eliminated.

7. AFAIK, these are tonic-clonic seizures and should be discussed in the seizure article, not this and not epilepsy.

8. Both the seizure and the epilepsy article could do with more work. They are crying out for references.

Finally, the article currently says "people ... misdiagnosed as epileptic". This use of the word "epileptic" as either a noun or as an adjective for a person, is discouraged by the epilepsy community. As The Guardian style-guide says "Seizures are epileptic; people are not". See also Epilepsy Action: Terms to Avoid.

Regards, Colin°^Talk 13:48, 30 May 2006 (UTC).

Colin, thanks again. I think there may be some consensus here.

1,2,3. Accepted. I think your new intro sentence is fine.

4. "a common term used by the medical community". Wikipedia isn't just for people with a medical degree. I think the essence of an encyclopedia should be clarity (not necessarily simplicity), and one of the cornerstones of clarity is plain English. Therefore if a phrase or term is likely to be misinterpreted by a "lay" reader (or indeed any reader) then it should be explained clearly.

The phrase "non-epileptic seizures" may indeed be widely quoted. However, this does not prove that, in each case, it refers to the same phenomenon.

To me the term "epileptic seizure" denotes a seizure which occurs due to epilepsy. Until the diagnosis of epilepsy is made, the event is simply a seizure. It is misleading (I would say wrong) to call any seizure an "epileptic seizure" unless epilepsy is present.

You challenge me to identify the difference, and indeed, where we are talking about a primary generalised tonic-clonic seizure, there is no practical difference. On the other hand, a patient with eclampsia, who undergoes a seizure, also has an identical seizure. It would be wrong to call that seizure an "epileptic seizure", since it is caused by eclampsia, not epilepsy. Likewise, it would be wrong to call a primary generalised seizure an "eclamptic seizure", if it happened outwith eclampsia. Just because a seizure looks like an epileptic seizure, does not mean it is one, and therefore it should not be labelled as such. That is why I like the term "epileptiform", and why I take issue with your phrase "Both are epileptic seizures". They are not.

The frequency of the term "epileptiform seizure" may indeed be less than the term "epileptic seizure". This, however, says nothing about how either phrase is applied.

Seizures which are not caused by epilepsy are not "inferior" to epileptic seizures. What matters to me here (and the distinction I am trying to preserve) is that the diagnosis of epilepsy should not be misapplied, nor mis-implied. Let me make an example. A young man falls over and has a bump on the head, followed by a witnessed tonic-clonic seizure. Thereafter he is fine for the rest of his life. He doesn't have epilepsy. His seizure was not an epileptic seizure.

Now supposing two weeks after his injury he has another, unprovoked, witnessed tonic-clonic seizure. And later, another, and another. He gets referred to a neurologist, is diagnosed as having epilepsy, gets put on anticonvulsants, his driving licence is revoked and he cannot lock the bathroom door when he goes in the bath. He has epilepsy. His first seizure was not an epileptic seizure, but the others were, even if they were identical in every respect. His quality of life is significantly impaired.

A leading theme of this article is that there are many events which look like epilepsy, and many people are misdiagnosed with epilepsy. Why then must we further cloud the issue by referring to things which we know are not epilepsy as "epileptic"? Epilepsy is one thing. Seizures without epilepsy are another, and events which look like seizures are another still.

5.Accepted.

6, touching on 4. One of my major criticisms of the medical literature is that sometimes rival workers have different terms for what is, effectively, the same thing. An example is the phenomenon of sideropaenic dysphagia, which is known as Paterson-Brown-Kelly syndrome, or alternatively Plummer-Vinson syndrome, depending on where you live. Nobody (least of all the workers themselves) can seem to sort it out and give it a single name. To a lesser extent, this happens commonly. Therefore the eminence of workers who use any term is less of a concern to me than the usefulness or validity of the term. I think we all agree that "grand mal" is not a helpful term, so we've thrown it out, even although it has been previously used by people with considerable expertise.

When I write for any publication, I aim for clarity and accessibility first. This may occasionally mean defining conflicting or misleading terms. Wikipedia isn't part of the medical literature, and I feel it even more important that even-handedness, simplicity and clarity should be our aim.

7, 8.Accepted.

Epileptic people. This sounds quite reasonable enough. I can see how the epilepsy community might prefer a different phrase. However, the use of diagnoses as adjectives is widespread and not intended to be pejorative. I have changed the phrase.

The irony is that this discussion is now several times longer than the article in question. Preacherdoc 03:18, 31 May 2006 (UTC)Preacherdoc.

Epileptic seizure

Your restrictive definition of an epileptic seizure is certainly clear, and rational in a quirky way. However, it is also wrong. There is no requirement for a pre-existing diagnosis of epilepsy. There is no distinction between the first and the second seizure. And there is no need to exclude invoked seizures such as febrile convulsions or eclampsia. Indeed, epilepsy is defined in terms of "epileptic seizures", not the other way round.

The International League Against Epilepsy (ILAE) define

An epileptic seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.

Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure.

An interesting article on The National Society for Epilepsy web site (The significance of the syndromic diagnosis of the epilepsies) gives a very rigorous definition of various terms. Included are

"An epileptic seizure is defined as an abnormal paroxysmal discharge of cerebral neurones sufficient to cause clinically detectable events that are apparent to the subject, an observer, or both"

and (from the World Health Organization Dictionary of Epilepsy, written by H. Gastaut):

Epilepsy is a chronic brain disorder of various aetiologies characterised by recurrent seizures due to excessive discharge of cerebral neurones (epileptic seizures), associated with a variety of clinical and laboratory manifestations). Single or occasional epileptic seizures (such as febrile convulsions and the seizures of puerperal eclampsia) as well as those occurring during an acute illness should not be classified as epilepsy.

The term "epileptic siezure" is used wrt eclampsia, both in the definition above and, for example, this article.

The term "epileptiform seizure" is not defined or even used by the ILEA, nor by any significant epilepsy organisation or textbook. It appears is a reltively tiny number of papers and web sites. It is clear that this term does not have popular support and I feel strongly that its inclusion here muddies the waters.

The term "non-epileptic seizures" is widely and consistently used with the meaning defined by this article.

I agree with your aims, and the importance of making this encyclopedia accessible to non-medical readers. However, this can be achieved by using standard terms and definitions that are precise and commonly accepted by the experts.

Colin°^Talk 12:47, 5 June 2006 (UTC)

Colin, I object to the term "quirky", which I find offensive. I still disagree with you (and the sources you quote) about the term "epileptic seizures". I still feel strongly that the word "epileptic" should be avoided unless the diagnosis of epilepsy is present. (A leading theme of this article as it stands is that epilepsy is mis-diagnosed. Surely this usage will make this more likely?). Unlike you, however, I do not routinely read the literature on seizure disorders. My source of expertise was asking everybody round the tables in the doctors' lounge in my hospital. It may come as no surprise to you that everyone agreed with my viewpoint (perhaps there is a geographical bias at work). However, I hope that these discussion pages will allow readers to see that some inconsistency in terminology exists. I'm not going to take this discussion any further, as it would be a waste of both our time. Preacherdoc 21:35, 5 June 2006 (UTC)Preacherdoc.

I appologise if you found the term "quirky" offensive. It was not intended to be derogatory in any way. I was attempting to find a way of describing the temporal nature of your definition (i.e. that what something is, changes depending on when it occurred – which is highly unusual).

I am trying to stick to Wikipedia:Verifiability#Verifiability, not truth here. I believe I've found the best references from the highest authorities available to me. These people may be wrong, but that is not important to Wikipedia. Believe me, if I had found sources to support your position, I would have mentioned them. Colin°^Talk 22:23, 5 June 2006 (UTC)

I just wanted to add that alcohol consumption is another cause of seizures, yet I haven't found any sources that explain the mechanism behind. --Hecajoda (talk) 14:31, 16 January 2008 (UTC)

Masturbation

Having read the source material cited in the claim that infantile gratification disorder is a cause of seizures, it appears to me that the material is being misinterpreted. The article appears to conclude that infantile gratification disorder can be MISTAKEN for seizures, and should be ruled out when a diagnosis of seizure is being considered. I have deleted the reference. 67.170.193.56 (talk) —Preceding undated comment was added at 06:48, 30 September 2008 (UTC).

I did the same with the reference to "breath-holding spells of childhood." No source was cited, but the Wiki article linked to again referred to this as an event that can be mistaken for seizures. It should not be listed as a cause of seizures. 67.170.193.56 (talk) —Preceding undated comment was added at 06:50, 30 September 2008 (UTC).

I think you misunderstand the topic of this article: it concerns events that look like seizures, are frequently misdiagnosed as seizures, but are not seizures. Colin°^Talk 21:12, 30 September 2008 (UTC)

Reflex anoxic seizures

I have come across this page and find it to be listed in the wrong place. I have Reflex Anoxic seizures and if someone was searching the internet after their child or themselves had been newly diagnosed they would find this information misleading and uninformative. Information is sparse enough without this rubbish. Either get your information right and stop talking about epilepsy or delete this whole page. —Preceding unsigned comment added by JC1663 (talk • contribs) 05:01, 31 December 2008 (UTC)

The the Reflex anoxic seizure article currently redirects here. This article is about NAS in general. I've removed the copyright text, which was added about RAS. If I find some time, I'll add some non-copyright text to a new article about RAS. Colin°^Talk 07:39, 31 December 2008 (UTC)