NEED FOR UNDERSTANDING NEAD (NON-EPILEPTIC ATTACK DISORDER)

Understanding that you are having a NEAD is like a sudden realisation of your true illness, that you may not have true epileptic seizures, and that you have not responded to treatment, because you were not diagnosed with this all this while!

Nirmal, a 57 years old gentleman suffered from epilepsy for twenty years. His seizures were characterized by falls, generalized shaking, obtundation, incontinence (loss of control over bowels and bladder). These events were brief and debilitating. He had repeated normal EEGs, but history was characteristic of seizures. A Video EEG test confirmed his seizures as resulting from NEAD, and he was referred to clinical psychologists for further management. His antiseizure medications were stopped, which made him feel much brighter during the day time. He still visits my office to profusely thank me, for the final diagnosis eased his life significantly.

Non-epileptic seizures can be tricky to diagnose and treat. These may be a small number of unfortunate few people who get treated with antiseizure medications for years together. And they have no response to treatment. They continue antiseizure medications with the fear of seizure recurrence looming over them, and yet, seizures continue to manifest.

I diagnosed three such patients last month and directed them through appropriate pathway for further management. One was a teenage girl post epilepsy surgery, who continued to have seizures. there was a looming fear that epielepsy surgery might have failed. A detailed history confirmed the diagnosis, and was a huge sigh of relief, that her Epilepsy surgery was successful, however she had developed new kinds of events- non epileptic events post-surgery. Another was young married woman with ongoing seizures of unknown etiology not responding to two antiseizure medications in good doses, and a boy who had been recently diagnosed with seizures, and antiseizure medications were contemplated. The latter two patients continue to do well, without antiseizure medications.

Non-epileptic attack disorder (NEAD) can be incredibly hard to diagnose, and investigations may not be helpful, if these are not clinically suspected. They do not follow a pattern, and do not abide by any diagnostic criteria. NEAD may be highly confusing and may resemble true seizures. In common parlance, these are also called as pseudo seizures/ paroxysmal non epileptic events (PNES). Some of the patients may present with multiple injuries as well, which is a common reason why they are started on medications for preventing seizures. NEAD can coexist with true seizures and knowing them cannot be overemphasized to titrate the correct treatment.

The best person to accurately diagnose these is your epileptologist. If your epileptologist has high index of suspicion, a video EEG may be arranged, which may confirm the clinical diagnosis. The EEG activity during the NEAD events may be normal. EEG in normal patients can show artifacts/ benign nonepileptic variants, that can be reported as abnormal by an untrained eye, and patients adhere to the rigmarole of failed medication history.

NEAD may be a manifestation of underlying psychological conflict and overwhelming stress. These can be effectively managed with appropriate neuropsychological intervention. NEAD can pose itself as a refractory epilepsy, if not diagnosed correctly. On the plus side, it is something which is remarkably amenable to treatment, in the right hands.

Contact Dr Madhuri Khilari/ book your appointment on https://www.apollo247.com/doctors/dr-madhuri-khilari-b0204b46-1894-4698-8b20-dd60b7e47a39, to know more about NEAD.