Distinguishing between nonepileptic attack disorder [pseudoseizures] and epilepsy can be very difficult and may need lengthy acquaintance with and study of the patient. The diagnosis should not be rushed, especially since many patients have both kinds of attack. Unfortunately repeated dramatic seizures are unnerving for both doctors and nurses and hasty treatment often takes precedence over careful observation.<sup>5 Betts T. Pseudoseizures: seizures that are not epilepsy Lancet 1990 ;  336 (8708) : 163-164  [cross-ref]

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Pseudoseizures (also called nonepileptic, hysterical, or psychogenic seizures) are paroxysmal changes in behavior that resemble epileptic seizures, but are without organic cause and are without simultaneous electroencephalogram (EEG) changes suggestive of epilepsy. They include behaviors that resemble syncope and all types of seizures: generalized, complex partial, simple partial, absence, myoclonic, frontal lobe seizures, and apparent status epilepticus. In DSM–IV<sup>4 American Psychiatric Association Diagnostic and statistical manual of mental disorders Washington, DC: American Psychiatric Association (1994).  457

Cliccare qui per andare alla sezione Riferimenti</sup> they are usually categorized as conversion disorder with seizures or convulsions, or in combination with other conversion symptoms as the mixed presentation subtype of conversion disorder.

Pseudoseizures are a somatic communication of mental distress, generally in response to a psychologic conflict or other stressors. Most pseudoseizures are conversion phenomenon or involve nonsomatic dissociative processes (such as trance states with amnesia or unresponsiveness). Some paroxysmal behaviors that are diagnosed as pseudoseizures are not conversion seizures, but are symptoms of other mental disorders such as panic episodes, cataplexy, or dissociative trance states that are mistaken for seizures.<sup>2 Alper K. Nonepileptic seizures Neurol Clin N Amer 1994 ;  12 : 153-173

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The diagnosis of pseudoseizures is often missed because the seizures are presumed to be epileptic. The consequences of misdiagnosis are considerable: delay of appropriate psychologic treatment, exposure to medication toxicity, unnecessary health care costs, and imposition of the stigma and lifestyle restrictions associated with epilepsy. Misdiagnosis contributes to pseudoseizures becoming chronic in two thirds of patients.<sup>10 Buchanan N., Snars J. Pseudoseizures (non epileptic attack disorder): Clinical management and outcome in 50 patients Seizure 1993 ;  2 : 141-148  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Among tertiary care epilepsy center patients, the median delay between pseudoseizure onset and diagnosis is 3 to 10 years, and occasionally proper diagnosis may not occur for several decades.<sup>9 Bowman E.S., Markand O.N. Psychodynamics and psychiatric diagnoses of pseudoseizure subjects Am J Psychiat 1996 ;  153 : 57-63

Cliccare qui per andare alla sezione Riferimenti, 27 Lempert T., Schmidt D. Natural history and outcome of psychogenic seizures: A clinical study in 50 patients J Neurol 1990 ;  237 : 35-38  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 29 Meierkord H., Will B., Fish D. , e al. The clinical features and prognosis of pseudoseizures diagnosed using video-EEG telemetry Neurology 1991 ;  41 : 1643-1646

Cliccare qui per andare alla sezione Riferimenti</sup> Consequently, the ineffective treatment of 49% to over 90% of pseudoseizure patients with anticonvulsant medications may last many years.<sup>24 Lancman M.E., Asconapé J.J., Graves S. , e al. Psychogenic seizures in children: Long-term analysis of 43 cases J Child Neurol 1994 ;  9 : 404-407  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 28 Luther J.S., McNamara J.O., Carwile S. , e al. Pseudoepileptic seizures: Methods and video analysis to aid diagnosis Ann Neurol 1982 ;  12 : 458-462  [cross-ref]

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