- Pseudoseizures
- Also known as psychogenic seizures or nonepileptic events
- Clinical events with altered movement, emotion, sensation,
or experience similar to those due to epilepsy but without an EEG
seizure correlation.
- They are surprisingly frequent
- occurring in up to 20% of
patients at epilepsy referral centers and in 5-20% of outpatient
populations.
- Estimated 10-60% of epilepsy patients have both pseudoseizures
and epileptic seizures.
- Clues to suggest a possible diagnosis of psychogenic “seizures”. None
of these factors by themselves exclude the diagnosis of epilepsy or reduce the
need for an appropriate evaluation.
- Normal neurological history and examination
- No evidence for remote symptomatic neurological disease
- Unremarkable routine EEG and MRI
- History of physical, sexual or emotional abuse
- Prior psychiatric treatment
- Prolonged clinical spells
- No response to AED medication
- “Unusual” behavior during spells, e.g., headache, pain or crying.
- Factors that suggest the diagnosis of a true seizure disorder:
- Spells that occur during sleep (not just occurring at night)
- EEG-identified interictal epileptiform alterations
- MRI-identified lesion or hippocampal atrophy
- “Prolonged” spell remission with AED medication
- History of generalized tonic-clonic seizure activity
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