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NEAD Case 1
NEAD Case 2
NEAD Case 3
Health and Wellbeing of People
with Epilepsy and Non-epileptic Attack Disorder

Marcus Gurr


NEAD Cases
Epilepsy is a chronic condition characterized by recurrent, unpredicable and
usually unprovoked seizures
3
. Epileptic seizures result from a transient
disequilibrium of cerebral excitatory and inhibitory influences causing an
electrical storm of excessive neuronal discharge
4
.
Precipitants of seizures include stress, anxiety or tension. Seizure deterioration
may be related to consequences of anxiety affecting health behaviours and
somatic manifestations.

Epilepsy Cases
Background
Case Stories
Questionnaire Results
Discussion
Non-epileptic Attack Disorder (NEAD) is a disorder of change in behaviour or
movement, not caused by a change in electrical activity of the brain
5
. It is
characterized by altered movements, sensations, changes in speech, breathing
and experience of loss of control or awareness. Predisposing factors increase
the likelihood of developing NEAD. Precipitaors occur prior to the onset of
NEAs and include stress, challenging life events or health problems.
Perpetuators are those responses preventing a person from gaining control or
overcoming a viscious cycle of stress symptoms coping failure stress.
Outcomes demonstrate that epilepsy patients experience substantial
difficulties affecting their physical and mental health, coping ability and social
roles.
NEAD patients show mostly normal functioning in the tested areas. Their
results are in contrast to their interview presentation and their demonstration
of severe health problems in the form of non-epileptic attacks.
These interesting clinical findings should be followed by thorough and
systematic research investigating:
The relationship between epilepsy and resulting impact on health
and quality of life, and
The relationship between functioning and levels of distress in
NEAD patients.
The outcomes of these case studies resulted in the creation of a Condition
Management Group for Patients with Seizures at the neuropsychology
department in Poole. This intervention aims to optimise participants physical
functioning, coping ability and mental health.
It appears that interventions are required which are based on a
bio-psycho-social understanding of these conditions in order to reduce the
complex effects of such conditions on patients lives.
Consequently, neurology departments should seek opportunities to expand
their services to include experts (e.g. neuropsychologists) who can offer
evidence-based interventions for such complex conditions.
References:
1
Reuber M. (2009).
2
Jacoby & Thalbar (2009).
3
Epilepsy Foundation (2010).
4
Epilepsy Action (2011).
5
National Institute for Health and Clinical Excellence (2012).
Contact: Marcus Gurr, Neuropsychology Service, Poole Community Clinic, Shaftesbury Road Poole BH15 2NT, margurrr@gmail.com
Acknowledgment:Thank you to Rebecca Jones, DHUFT manager for funding this poster; to Jac Dendle for contributing epilepsy case 2 and to Dr B Gurr, neuropsychologist,
for guidance on this project.

NEAD Case 1: 58 year old male

This patient generally sees his life in a positive way, but is also very ambitious
and a self-described perfectionist. Because of this he induces a lot of stress
when not reaching personal goals. This may have been a major reason for his
NEAs. An eye operation just before his first seizure might have been a more
specific trigger. He is coping well with his condition and accepts his limitations,
although he does feel some regret about having to take early retirement.

NEAD Case 2: 25 year old female
This patient has cerebral palsy, which may have created a physical vulnerability
in her childhood. This predisposing factor may have reduced her coping ability
regarding stressful events in later life such as: neighbour problems, parents not
accepting her relationship and her husbands compulsive buying. She is
struggling to maintain control of her life and is apprehensive about asking her
parents for help because of their non-empathetic reactions.

NEAD Case 3: 32 year old female

This patient may have had some predisposing factors which could have
contributed to her current symptoms. She grew up in a very unstable and
unsafe family situation. This lack of attachment at an early stage of life meant
that she was in a vulnerable state, predisposing her to stresses in later life,
which came in the form of a managerial position at work. She is very anxious to
get better quickly, continue her work and seem normal to others around her.
Outlook Outcomes
Epilepsy Cases NEAD Cases
This poster illustrates health and psychosocial factors which predispose, precipitate and perpetuate epilepsy and non-epileptic attacks in the presented cases.
Assessment profiles of these cases demonstrate their health perception, physical functioning, psychological wellbeing and coping abilities.
The profiles are understood in the context of a bio-psycho-social model of NEAD
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and a model linking epilepsy and anxiety
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.

Epilepsy Case 1: 36 year old female
This patients epilepsy started in her adult years and is now mostly controlled by
medication. She also has NEAs. She had migraines and illnesses during
childhood and describes her current problems as the icing on the cake. She has
marital problems and feels that her condition is interfering with improving these
and the rest of her social life. She is striving towards creating a normal family,
something which she feels she has never had. A range of test scores indicate the
most severe levels of anxiety and the experience of reduced health and well-
being. She is very hypervigilant regarding her condition and symptoms.
Consequently, she will sometimes stay indoors for 2-3 days, which then leads to
her feeling isolated and lonely.
Epilepsy Case 2: 64 year old female
This patient experienced a stroke and has subsequently developed epilepsy.
She has a self-reported history of anxiety and stress. Her seizures are
unpredictable and often result in paramedic attendance and occasional hospital
admission. She reports being extremely anxious about suffering seizures and
worries about hurting herself. She requires the constant support of her husband
and is functionally restricted by seizure anxiety.
Epilepsy Case 3: 25 year old female
This patient developed generalized epilepsy at the age of 20. The first three
seizures coincided with critical events in her life. As a child she experienced
recurrent migraines and reported catastrophic mental responses to normal
situations. These factors might have predisposed her to her condition, which she
struggles to accept.
severe
clinical range
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mild-moderate
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Epilepsy Case 1
Epilepsy Case 2
Epilepsy Case 3
severe
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mild-moderate
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normal
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