General Practitioner, 7 years’ experience, UK

This chapter details the stories of two patients which illustrate the confusion and uncertainty that surrounds Non-Epileptic Attack Disorder (NEAD). The first patient has multiple health problems. His medical records list the following diagnoses: reflex anoxic seizures, epilepsy, NEAD, Chronic Obstructive Pulmonary Disease (COPD), heart failure, anemia, and a small meningioma. On a busy on-call, he presented with acute confusion, fever, and tachycardia. Once on the ward, he had a prolonged seizure. This was diagnosed as an acute symptomatic seizure and follow-up in the Neurology clinic was arranged. The patient did not attend the follow-up appointment, but he had another seizure a few weeks later in the street. An ambulance took him to the hospital and the very brief discharge summary referred to “dissociative epilepsy.” Unfortunately, the patient declined psychotherapy because the seizures were “not in his mind.” He was equally reluctant to start other antiepileptic drugs in addition to his long list of other medications. Meanwhile, the second patient’s medical records referred to localization-related epilepsy, generalized epilepsy, and NEAD. However, like the first patient, the second patient resisted psychotherapy.