Seizure clinic encounters: Third party references and accompanying others.

There are two different types of seizures, epileptic and psychogenic non-epileptic seizures (PNES) - the seizures can look the same and have the same features. Despite the impressive increase in our biomedical knowledge it is difficult for neurologists to differentiate between these seizure conditions; and many of the tests used cannot, on their own, confirm a diagnosis. However, it is crucial to get the diagnosis right because the choice of treatment critically depends on the cause and nature of the seizures. Consequently, history-taking and the interaction between patient and doctor remains key to the investigation and correct and effective treatment of epilepsy and PNES. Recent research indicates that the close examination of doctor-patient encounters not only enables us to identify linguistic and interactional features that help with the diagnosis of epilepsy and PNES, but also yields helpful psychological insights into how people with seizures experience their disorder. Previous work has alerted researchers (and neurologists) to the important role that references to others not present during consultations (third parties) can play. However, previous studies have not examined or described the use of these third party references in detail. This thesis investigates the use of third party references and seizure witness accounts by participants experiencing refractory seizure disorders using secondary data collected during 20 one-to-one doctor-patient consultations. Moreover, patients are routinely invited to bring seizure witnesses and companions along to their first as well as to subsequent visits to seizure clinics. Despite the important diagnostic roles companions are thought to play in these encounters, no previous studies have focussed specifically on their contribution to the interaction between patients and health professionals. To help advance what is known about accompanied interactions in the seizure clinic, 50 patients attending a specialist outpatient seizure clinic consented to participate in an observational study. Findings from this research, funded by the charity Epilepsy Action, help inform existing models of interactional criteria that distinguish between the linguistic and communicative features of PNES and epilepsy patient seizure descriptions. The findings suggest that doctors utilising the differential interactive, linguistic and topical features of seizure patient talk need to carefully consider how they conduct and structure these consultations, and recommendations are offered in this respect. Finally, avenues of future research are discussed.