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One important reason for therapeutic failure of epilepsy treatment is misdiagnosis of epilepsy. Several imitators of epilepsy [1] can confound even experienced clinicians. Among these imitators, nonepileptic (psychogenic) seizures (NES) can be particularly difficult to diagnose. Induction of NES by hypnosis or suggestion has been used since 1955. [2] This diagnostic maneuver, although useful, raises ethical issues pertaining to employment of placebos, informed consent, and the effect of deception on the patient-doctor relationship. In this review, we examine provocative testing for seizures in light of these issues.
Placebo use in medicine.
Neurologists use placebos during provocative testing to diagnose suspected conversion symptoms. Recent reviews address ethical issues of placebo use in controlled studies. [3] Here, we review a brief history of the placebo and consider ethical issues related to placebo use in provocative testing.
The therapeutic benefits of placebos have been recognized, directly or indirectly, since the dawn of civilization. Given the severe limitations of pharmacologic and surgical therapies until the current century, administration of a placebo was among the most effective therapeutic strategies. Robert Burton (1628) [4] recognized that "a silly chirurgeon, doth more strange cures than a rational physician ... because the patient puts his confidence in him." Mesmer's use of animal magnetism during the late 18th century, although disproved as fraudulent, became the forerunner of hypnotism and helped shape the future of dynamic psychiatry. [5] Thomas Jefferson (1807) viewed placebos as a "pious fraud," but noted that "One of the most successful physicians ... used more of bread pills, drops of colored water, and powders of hickory ashes, than of all other medicines put together." [6] In the late 19th century, Charcot used hypnosis and suggestion to explore various neuropsychiatric disorders, including conversion. In pioneering studies, he hypnotized patients to produce and relieve hysterical paralysis, mutism, and amnesia. Unfortunately, some of …
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