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Uma visão histórico-crítica do conceito de crise não-epiléptica psicogênica / An historical-critical approach to the psychogenic non-epileptic seizure concept




Psychogenic non-epileptic seizures are recurrent crisis, or attacks, or paroxysmal behavioral changes that can be misunderstood as epileptic seizure due to the behavioral similarity between both, however, these manifestations are not associated with abnormal electrical brain discharges that cause epileptic seizures. Non-epileptic seizures are classified into physiologic and psychogenic origin. The most common psychiatric diagnoses associated with psychogenic non-epileptic seizures are conversion disorder and somatization disorder. In clinical practice, the distinction between non-epileptic seizure and epilepsy challenges and confuses the clinicians, the neurologists and the psychiatrists, since ancient times. The long-term video-electroencephalographic monitoring video-EEG, considered as the gold standard for the differential diagnosis, has led to a significant increase in the number of cases of psychogenic non-epileptic seizures. Although being a clinical situation difficult to manage, with medical and social poor prognosis, it is evident that the instrumental and technological knowledge about non-epileptic seizures are insufficient to deal with this problem. The aim of this study is to enrich the comprehension of the psychogenic non-epileptic seizures in the last fifty years. The historical emergence conditions of the psychogenic non-epileptic seizure and its clinical practical implications were investigated. For this purpose, it was examined papers that discuss the concept of psychogenic non-epileptic seizure in three neurological journals and in three psychiatric journals. This research was guided by epistemological projects focused upon conditions of possibility for reflexive thinking about conceptualization, changing and formalization of the concepts, theories and practices. The methodological approach was influenced by Canguilhems and Bachelards historical epistemology, pursued by Foucault´s critical analysis and culminating in Habermas e Gadamers hermeneutics thought. The research pointed out that hysteria and epilepsy concepts have been reformulated over time, and uncovered fundamental concepts that organized psychogenic non-epileptic seizures in different historical periods. In the 1970s, there was a predominance of papers that discuss the reduction of hysteria and the hysterical personality in women. In the 1980s, there was a concern with the development of diagnostic instruments and structured interviews, and an explosive increase in the number of papers in the neurological journals discussing the use of video-EEG. In the 1990s and on, papers have been focused on the multiple psychiatric diagnoses and research on dissociation and abuse associated to psychogenic non-epileptic seizure. The conclusion is that psychogenic non-epileptic seizures, as scientific knowledge, have a history, which interact with various kinds of knowledge and it is influenced by social variables. In this sense, the possibility of openness and dialogue between technological and practical dimensions could provide underlying conditions to a better and more integral care model among patients with psychogenic non-epileptic seizures


epilepsia/diagnóstico convulsões differential hysteria/history seizures epilepsy/diagnosis diagnóstico diferencial histeria/história