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In Reply

SIR: Dr. Derakshan accurately summarizes the literature on temporal lobe seizures and impairment of verbal consciousness and speech automatism. Verbal consciousness is impaired by dominant temporal lobe seizures and automatic speech (resulting from preserved dominant speech cortex) occurs most often with nondominant temporal lobe seizures. However, our study concerned nonepileptic conversion seizures.

I strongly disagree with his assertion that one should never diagnose conversion symptoms or conversion disorder in a patient with a "neurological" disorder. Indeed, there is extensive literature suggesting that patients with structural brain lesions (e.g., tumor, stroke, multiple sclerosis, trauma) or neurophysiological disorders such as epilepsy have an increased incidence of conversion disorder.^1–4 I would also disagree about any data on lateralized ictal motor automatisms and hemispheric dominance. Rather, partial seizures with lateralized ictal motor automatisms usually start from the ipsilateral hemisphere.⁵

REFERENCES

1. Barry E, Krumholz A, Bergey GK, et al. Nonepileptic posttraumatic seizures. Epilepsia. 1998;39:427–31
2. Eames P. Hysteria following brain injury. J Neurol Neurosurg Psychiatry 1992;55:1046–1053
3. Caplan LR, Nadelson T. Multiple sclerosis and hysteria. JAMA 1980;243:418–421
4. Devinsky O, Mesad S, Alper K. Hemisphere lesions and conversion nonepileptic seizures. J Neuropsychiatry Clin Neurosci 2001;13:367–73
5. Chee MW, Kotagal P, Van Ness PC, et al. Lateralizing signs in intractable partial epilepsy: blinded multiple-observer analysis. Neurology 1993;43:2519–25

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