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"You'd better ask the doctors here about my illness, sir. Ask them whether my fit was real or not.''--Smerdyakov to Ivan in The Brothers Karamazov [1]
A subgroup of the patients seen for the treatment of seizures are patients who do not have epilepsy. These may constitute some 20% of patients at epilepsy referral centers. [2] Assuming [3,4] that epilepsy centers primarily serve patients with intractable seizures (but not only or all such patients), that patients with intractable seizures are about one-third of all patients with epilepsy, and that the point prevalence of epilepsy in the United States is 0.6%, there may be several hundred thousand patients with pseudoseizures in the United States, and analogous numbers of patients elsewhere. Pseudoseizures are frequently misdiagnosed, perhaps because the manifestations of the disorder are variable. Patients can continue having episodes for years. Some suggest that the longer the episodes continue to occur, the less likely they are to come under control. [5] For this reason it is important to know the characteristics of this disorder, so that appropriate and early treatment can occur. The literature discusses the relative advantages or disadvantages of various terms, [2,6,7] but no one term is entirely satisfactory. "Psychogenic seizure'' and "pseudoseizure'' are the most commonly used and they will be used somewhat interchangeably in this review.
Psychogenic seizures are episodes of altered movement, emotion, sensation, or experience, similar to those due to epilepsy, but which have purely emotional causes. King et al. [8] assessed the accuracy in differentiating episodes of epilepsy from pseudoseizures by three groups. They found that admitting physicians correctly determined episodes as due to epilepsy in 14 of 17 cases. Hospital monitoring personnel correctly diagnosed these in 8 of 10 cases, and a neurologist viewing the videotape without knowledge of the EEG findings did so …
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