Use of induction procedures in diagnosing psychogenic seizures

To determine the use of procedures or techniques designed specifically to precipitate events in patients suspected of having psychogenic seizures, a survey regarding induction procedures was conducted by soliciting information from physicians and nurses at 60 epilepsy programs which are members of The National Association of Epilepsy Centers. A survey instrument was used to (a) identify prevalence, methods, and protocols of induction use (i.e., to identify the ''standard of care'' regarding this procedure); (b) identify reasons for use and nonuse of induction procedures; and (c) determine whether physicians' responses and nurses' responses differed regarding their views and perspectives about induction procedures. Responses were received from 51 of 60 centers, for a response rate of 85%; 27.4% of centers do not use induction procedures of any kind. Of the centers using induction procedures, 56.8% use intravenous saline and 29.7% use a placebo patch. Most centers use two or more techniques, commonly combining intravenous saline or placebo patch with hyperventilation, photic stimulation, or verbal suggestion. Additional findings from the study regarding mental health consultation, concerns expressed by health professionals, and ethical issues are reported.