Nepal Journal of Neuroscience
Official Journal of Nepalese Society of Neurosurgeons
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Analysis of Patients with Fainting Attack and Psychogenic Non Epileptic Seizure in a Tertiary Hospital Setting in Nepal.

Rabindra Shrestha, MD, KN Shakya, MD
Rabindra Shrestha, MD Department of Medicine Kathmandu Medical College Teaching Hospital Kathmandu, Nepal KN Shakya, MD Department of Pediatrics Kathmandu Medical College Teaching Hospital Kathmandu, Nepal

Abstract
Temporary loss of consciousness (LOC) may be caused by many factors. Many patients with LOC are misdiagnosed as suffering from “seizure disorder.” This prospective clinical study was designed to find out the different causes of “fainting attack” and the proportion of psychogenic non-epileptic seizure (PNES). All patients with history of LOC from March 2007 to March 2008 were evaluated. Obvious generalized tonic clonic seizure was excluded, PNES being the diagnosis of exclusion. Patients were subjected to electro encephalography (EEG) and computed tomography (CT) scan of head only in doubtful cases. A total of 52 patients were included in the study. The mean age of the patients was 22.5 years. Twenty six (50%) patients had seizure disorder; out of this 18 patients were males and eight females. PNES was seen in 20 (36%) patients; 12 (60%) were females and eight (40%) were males. 40% of these PNES were unnecessarily taking AEDs. In a tertiary hospital set up in Nepal, only 50% of fainting attacks were due to true seizure. Therefore, PNES needs to be excluded in patients presenting with loss of consciousness before considering treatment with AEDs, especially if the patient is a young female.

Key Words: antiepileptic drug, fainting attack, pseudo seizure, psychogenic non epileptic seizure