From epileptic hysteria to psychogenic non epileptic seizure: Continuity or discontinuity for contemporary psychiatry?
Résumé
In the wake of Charcot, the École de la Salpêtrière became passionate about major crises or hysterical attacks: at the time, hysteria was not just about this great crisis, even if it represented an ideal heuristic model for a patient presentation that left a lasting impression on people's minds. The great attack is a framework for the study of hystero-epilepsy that opens the way to psychopathological explanation. The heirs of the Salpêtrière School's knowledge protesters each boast of imposing a universal model of hysteria seen from the perspective of its causes. If Babinski considers hysteria to be a purely psychogenic mechanism, it is of the subconscious mind or self-suggestion, the subject abandoning himself to his symptom. Unlike pithiatism, Freud and Breuer understand crisis as the cleavage of the content of consciousness that testifies to the return of a forgotten traumatic memory. These questions, partly eclipsed by modern psychiatry, are resurfacing with the description of a new clinical entity: the nonepileptic psychogenic seizure.Non-epileptic psychogenic seizures (PNES) can be defined as paroxysmal manifestations clinically suggestive of epileptic seizures but related to unconscious psychogenic processes. Clinical diagnosis is particularly difficult. Most patients with PNES incorrectly use anticonvulsant therapy, which is ineffective and has frequent side effects. To establish a diagnosis that discriminates between PNES and epilepsy, the electroencephalographic recording coupled with a video recording is the paraclinical examination of choice. The treatment of PNESs is complex: despite a diagnosis made by the patient and joint follow-up by a specialized team of neurologists and psychiatrists, the prognosis remains uncertain.We sought a phenomenal continuity between a major hysterical attack, hystero-epilepsy and a non-epileptic psychogenic seizure. From one time to another, the diagnosis of epileptic seizures is a diagnosis of clinical and paraclinical elimination. A reference to hysteria is found over time, currently confusing into dissociative and somatoform disorders. Consistent with ancient theories, the psychotraumatic dimension of the epileptoid phenomenon is found in recent epidemiological studies.Since hysteria was not just about major attacks, the entity called PNES is a group of clinical manifestations with heterogeneous etiologies. Some research teams consider PNESs to be the result of non-epileptic, normal electroencephalogram neuronal hyperexcitability. Other authors have adopted the etiological hypothesis of recurrent dissociative disorders and equivalent to a particular form of post-traumatic stress disorder.
Domaines
Psychologie
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