Brendan’s fits seemed like epilepsy, until we looked into his emotional life

Dr Phil Whitaker’s Health Matters column. 

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Daytime emergencies are always disruptive. Patients with appointments end up waiting for ages and colleagues have to squeeze extra people into already congested lists to deal with the backlog. So when a call from the son of the 70-year-old Brendan was put through in the middle of morning surgery, I took it with some foreboding.

“Dad’s having another fit,” he told me. “I was going to phone the ambulance but the hospital told us to ring you if it happened again.”

This struck me as unusual advice, so I speed-read the last hospital letter in his notes. Brendan had had three “blue-light” admissions with fits but the consensus was that they weren’t epilepsy. The provisional diagnosis was pseudoseizures and it was suggested that emergency admission would not be appropriate for future episodes. Brendan’s son sounded understandably stressed. I was going to have to visit.

Brendan was still fitting when I arrived – a bizarre pattern of involuntary writhing and inarticulate speech quite different to classical epilepsy. I was able to get him to co-operate with some instructions in the midst of it all, a finding also inconsistent with an ordinary seizure. I put the restive waiting room out of my mind and settled down to resolve the crisis by persistent reassurance.

Pseudoseizures – less pejoratively known as non-epileptic attack disorder, or NEAD – are a type of conversion illness: strange phenomena in which intolerable emotional stresses manifest as physical symptoms that don’t fit organic patterns. These include paralysis and mutism, as will be familiar to readers of Pat Barker’s Regeneration trilogy, which dealt with “shell shock” in First World War combatants.

In the months that followed, I got to know Brendan well. He’d never served in the military but his work with an international NGO had landed him in some sticky situations, including being held hostage at gunpoint during an African civil war in the 1970s. His personal life had been marred by tragedy; he’d fathered his son during an affair with a married woman, whom he described as the love of his life. She had died from cancer two years afterwards and her scandalised family had barred him from visiting her during her final months, so he never got to say goodbye.

Brendan is well educated and professed himself fascinated by my idea that his fits might be related to these past traumas. He is also pretty much the archetype of the stiff-upper-lipped Briton and was very polite in telling me he thought the whole thing was a load of bunkum. He undertook vast amounts of research, which reinforced his belief that he must have an unusual variant of epilepsy. His conviction wasn’t shaken by a second opinion from a nationally renowned neurological centre, or a fruitless trial of epilepsy medication.

The fits escalated, coming several times a day, disrupting life to such an extent that Brendan could barely leave the house. He started to fear that he wouldn’t be able to attend his son’s wedding the following year. He finally agreed to pursue psychological therapy, the only treatment to have any efficacy in NEAD.

The initial course was at a regional specialist centre in a nearby city. The approach was heavily behavioural, which Brendan experienced as deeply patronising. I was dismayed as relations between him and his therapists broke down. I began to worry that he would be among the two-thirds of NEAD patients unable to benefit from treatment.

Over the months, though, a bond of trust had developed between us, which must have played a part in his accepting my suggestion of a further referral to a national expert in NEAD psychological therapy at a hospital in a distant city – the funding for which I had to go to considerable lengths to secure.

Brendan’s son ferried him to and from the appointments over a 16-week period and to our delight, his fits – which had been going on for 18 months – gradually petered out. He eventually managed to witness his son, whose mother he had loved so much, get married. For all the disruption, I’m glad I went on that urgent home visit, which started Brendan and me on the long road to his eventual cure. 

Phil Whitaker is a GP and writes the New Statesman’s “Health Matters” column. His books include Chicken Unga Fever: Stories from the Medical Frontline (Salt)

This article appears in the 13 November 2014 issue of the New Statesman, Nigel Farage: The Arsonist

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