Pseudoseizures: a real problem!

Introduction of new anticonvulsants, widespread use of serum anticonvulsant-level measurement, and availability of equipment for simultaneous video-electroencephalogram (EEG) monitoring have shown that not everyone who has seizures has epilepsy, even when other medical conditions have been excluded. Non-epileptic seizures, or pseudoseizures, occur in 20% of patients with conversion syndromes and can be difficult to diagnose and treat. Patients with pseudoseizures do not respond to anticonvulsants, may display paradoxical reactions to prescribed treatment regimens, and may develop abnormal neurological signs as a result of anticonvulsant toxicity. Both epileptic and non-epileptic patients may suffer pseudoseizures, which should be suspected when seizures, which should be suspected when seizure control is unpredictable or difficult, or when ictal or post-ictal EEGs are normal and psychopathology is present. Video-EEG monitoring is the "gold standard" of pseudoseizure diagnosis. A case history illustrates how difficult the clinical diagnosis can be, and how useful a normal post-ictal EEG can be when the etiology of a seizure disorder is obscure.