Posttraumatic seizures in survivors of torture: manifestations, diagnosis, and treatment

Abstract

Survivors of torture are very likely to have been beaten repeatedly around the head. Apparent brief losses of consciousness are not uncommon following torture, and they may be associated with signs that suggest temporal lobe epilepsy (TLE). The relative risk of developing posttraumatic seizures (PTS) is increased by about 50% after a single head injury involving a brief loss of consciousness. It is 2.9 if that loss of consciousness lasts for more than about 30 min. Thus, patients who have been tortured are at increased risk of seizures. TLE is difficult to diagnose and needs specialist investigations, and other conditions that are not uncommon in survivors of torture, such as panic attacks, posttraumatic stress disorder, dissociation, and syncope can all present with similar pictures. This paper addresses the differential diagnosis of posttraumatic epilepsy in survivors of torture.