Epilepsie und dissoziative Anfälle

This article presents a narrative review describing the special features of the interaction of patients with dissociative seizures. It shows the potential in the knowledge of these features for the differential diagnosis of epileptic and dissociative seizures and their utility and application in clinical practice. Patients with epileptic seizures use the session with the physician to explain as much as possible about what happens during the seizures and how they are trying to cope with the seizures. We describe the way the communication differs from that when talking to patients with dissociative seizures: they tend to talk about the seizures without providing details and without describing the subjective experiences of the seizures. The descriptions usually stress the extent to which they are at the mercy of what is happening. They tend to become irritated by further questions about the experiences during the seizures and steer the conversation in other directions. To ensure that conversations with patients affected by dissociative seizures are helpful, it is important to be aware of these communicative peculiarities and to have insights into their importance for the diagnosis and treatment. We make definitive suggestions on how clinicians can deal with their own irritation and with the patient’s statements in such a way that both sides gain a deeper understanding of the problem. In this way the initial conversation can initiate the start of the therapeutic work. When children and adolescents are presented for clarification of seizure events, the differences in the presentation are usually even more readily apparent as they have less routine narrative and usually a much shorter medical history.