[Psychopathology in epilepsy and pseudoepilepsy: preliminary results in our experience]. / Psicopatologia nell'epilessia e nella pseudoepilessia: risultati preliminari nella nostra esperienza.

PURPOSE: Pseudoseizures or nonepileptic seizures (NES) are termed "nonepileptic psychogenic seizures" and account for approximately 20% of all intractable seizure disorders. These seizures are often misdiagnosed as true epilepsy, resulting in inappropriate, ineffective and costly treatment of many patients. Nowadays video-EEG monitoring have greatly improved the ability of specialists to correctly distinguish NES from epilepsy. Nevertheless, patients with NES do not always demonstrate obvious psychopathology. The aim of this study is to examine the complexity and severity of psychopathological features of patients with NES, in order to optimize strategies of intervention and appropriate long-term psychological and psychopharmacological treatment for these patients. MATERIALS AND METHODS: We evaluated three samples: patients with NES, patients with epilepsy and a control sample. Subjects with pseudoseizures and epileptic seizures have been randomly recruited from the Epilepsy Centre at the Neurology Institute of Catholic University of Sacred Heart of Rome. Seizures have been documented by the recording of spontaneous events with video-EEG, EEG, clinical observation and ictal examination. Each sample of patients has been tested using the Hamilton Rating Scale for Depression (HDRS), Dissociative Experience Scale (DES), Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Short Form Health Survey 36 (SF-36). RESULTS: 17 (4 M; 13 F) patients with NES, 13 (3 M; 10 F) patients with epilepsy and 16 (4 M; 12 F) control subjects were recruited. Our preliminary results confirm previous researches showing that NES typically manifest between 20 and 30 years of age and that approximately a three-quarters of all patients are women. Besides, they confirm that psychosocial, environmental and intrapsychic mechanisms interact in the aetiology of NES: in particular, our preliminary results are consistent with the hypothesis that traumatic experiences are important precursors to the development and expression of NES. CONCLUSIONS: This study has yielded promising results and confirm the necessity to improve our knowledge about psychopathology of patients with NES. Psychiatrists and neurologists should work in equipe to guarantee an adequate treatment for a pathology too long set aside and almost ignored from clinical research.

Ecological engineering - An idea whose time has come?

The era of cheap fossil fuels is nearing its end. industrial, agricultural and human pollutants have reached alarming levels in water, soil, air and stratosphere. Consumers no longer tolerate poisons in their food and water, are now concerned with global warming and ozone depletion, and value fields and forests for their scenery and wildlife as well as food and fibre. We are at the crossroads, searching for answers to these and many other pressing ecological problems. On one side sit 'deep ecologists' who patiently await the reactions of global Gaia. On the other sit 'biotechnologists' who would design and build new organisms and new ecosystems. The first approach is defeatist, for it awaits the decimation of the human population. The otheris activist, but will it work? Here we examine the idea of 'ecological engineering', which offers some promise of solutions to our problems if it can integrate the practical sides of ecosystem, landscape, community and population ecology with relevant formal concepts from the engineering sciences.