Terrence L. Riley

Pseudoseizures: recognition and treatment.

Abstract Pseudoseizures involve a subjective loss of consciousness, usually resulting from a psychological disturbance. Drug intoxication, panic or anxiety attacks, or hypoglycemia may also induce behavior that resembles epileptic manifestations. Multiple EEG evaluations and careful clinical observation can rule out epilepsy. Psychiatric treatment, including family interviews and sympathetic discussion of the underlying emotional problem with the patient, should be provided when appropriate.

Sleep Studies in the Subject's Home

Because the ambient environment affects sleep duration and sequence, sleep in the subjects home may be more valid than in a laboratory. Telephone polysomnogram transmission (TPSM) and portable electromagnetic tape recordings offer recordings in the subjects bedroom. Ten subjects were recorded in the laboratory and at home by TPSM and portable recording. Overall sleep patterns were similar with all three techniques, but sleep and REM latency were much shorter and REM duration much longer, and time awake after sleep onset was longer with laboratory recordings. These data show that sleep patterns in the home differ from recordings in the laboratory. Portable recordings provide the additional benefit of monitoring daytime cycles. TPSM affords seven or eight channels for more precise recording and sleep staging.

Patterns resembling tracé alternant in quiet sleep of an adult.

An 18-year-old man with lymphoma and Listeria meningitis developed a pattern similar to tracé alternant during quiet sleep. This is a pattern normally seen in the neonate during quiet sleep and probably represents diffuse brain disturbance of both cortical and deep gray matter if occurring in the adult, as with other discontinuous or burst-suppression patterns.

Managing the patient with peripheral neuropathy

Peripheral neuropathy may be a minor, even unrecognized, clinical problem, or it may be severe and virtually disabling. As in any chronic disorder, the physicians role is to look for treatable disease and to teach patients about the symptoms and natural history of the dysfunction as well as methods for coping with it. The physician can help patients by explaining how to contend with a damaged peripheral nervous system on a daily basis, even if healing or significant organic relief cannot be achieved.