Could an Interpretative Neurophenomenological Analyses of Seizure Discourse (INASD) contribute towards differential diagnosis of seizures?

Background

Differentiating epileptic seizures (associated with electrical brain discharges) from non epileptic seizures (NES) (manifestations of conversion or dissociative disorder) is a serious diagnostic challenge for neurologists. Receiving mistaken diagnosis and treatments can have grave, long term consequences.

Aims

My thesis documented and analysed detailed seizure descriptions using Interpretative Phenomenological Analysis (IPA)- which connects first person subjective accounts, cognitive processes and physical states - with a view to identifying features which could differentiate between epilepsy and NES.

Participants

Four people, newly referred to neurology whose diagnosis was unclear

Methodology

Seven in-depth, participant led, conversations

Analysis
Interpretation

P1, 2 & 3 were diagnosed with epilepsy. P1 & P2 elucidated detailed descriptions of their cognitions, levels and contents of consciousness, correlating with their diagnoses. The descriptions of P3, lacked this depth, correlating with those of NES patients in existing research. The lack of an available discourse for him to use could explain this or, his diagnosis could be NES. P4, having similarly ‘empty’ descriptions, to date, remains undiagnosed because of missed appointments.

For discussion

a) Capturing participants’ intuitive, subjective, experiences very early in the diagnostic process was invaluable because many descriptions were subsequently, significantly, ‘diluted’ . Given this, and P3’s lack of vocabulary, does this mitigate for or against training participants in neuro-phenomenological techniques in this context?

b) Epileptic seizures are the result of unfolding elements in a dynamic system , can be anticipated and are not sudden or unexpected. Could a pheno-dynamic analyses using videoEEG/neuroimaging/neurological correlates of cerebral activity compared with remembered subjective experiences, contribute towards the potential differentiation of the two seizure types?

Conclusions

Given that people’s subjective experiences can help locate seizure foci, there is potential for an INASD for the differential diagnosis of seizures.