Diagnosis of hysterical seizures in epileptic patients.

The coexistence of epileptic and hysterical seizures in the same patient is not rare and creates problems in diagnosis and management. The authors used simultaneous video-EEG monitoring to document the diagnosis of hysterical seizures in 9 epileptic patients; clear-cut hysterical seizures were seen in all 9. The authors used individualized re-educative psychotherapy to teach patients alternative coping techniques and discharged them on minimum dosages of anticonvulsants. None of the patients had a classical hysterical personality, which suggests that conversion reaction is a more appropriate diagnosis, The etiology of "hysterical" seizures varies; the authors emphasize individualized treatment and long-term follow-up.