Listening to people with seizures: How can linguistic analysis help in the differential diagnosis of seizure disorders?

Abstract

Despite advances in medical technology, the patients’ history remains the most crucial tool in the differential diagnosis of epileptic or non-epileptic seizures (NES). The distinction of these two types of seizures is a common and important task for neurologists. Whereas epileptic seizures would be treated with antiepileptic drugs, non-epileptic seizures are thought to be a manifestation of psychological or social distress and can improve with psychotherapy. This paper summarizes the findings of a series of multidisciplinary research studies undertaken at the Bethel Epilepsy Centre and the University of Bielefeld in Germany in which linguistic analysis was carried out to identify and describe linguistic and interactional features in clinical exchanges between doctors and patients with seizures. Two distinct communication profiles emerged in these studies based on the analysis of transcripts of over 110 doctor-patient encounters. Epileptic seizure descriptions are characterized by formulation effort, provide the doctor with a coherent account of individual seizures, relate subjective seizure experiences and use consistent metaphoric conceptualizations. Patients with NES tend not to volunteer subjective seizure symptoms, give accounts of their seizures which are difficult to understand and are inconsistent in their choice of metaphors.