Non-epileptic seizures (NES) are events resembling epileptic attacks, but lacking their characteristic clinical and electrographic features. They can be subdivided in psychogenic NES and physiologic non-epileptic seizures. Physiologic NES reportedly occur in 12-36% of patients with presumed epilepsy. The distinction between physiologic NES and epilepsy is important because patients misdiagnosed are often excessively investigated, inappropriately treated and have unnecessary restrictions. Additionally, once a diagnosis of epilepsy is given it is not easily removed. In differentiating between epilepsy and physiologic NES, the history is the most useful tool. Unfortunately, there is no particular constellation of clinical signs and symptoms with a good sensitivity and specificity for the diagnosis. Improper interpretation of an EEG, mainly because of the overinterpretation of benign EEG patterns, is one of the cardinal errors inducing a misdiagnosis. EEG video-telemetry has as yet no reliable equivalent for the differential diagnosis.
epilepsy; nonepileptic seizures; psychogenic nonepileptic seizures; physiologic nonepileptic seizures
