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| Non epileptic events |
 | Main differential diagnosis of Nonepileptic Physiologic Events
 | Autonomic disorders |
| Cardiac
 | vasovagal syncope |
| arrhythmias |
| ischemic heart disease |
| orthostatic hypotension |
| valvular heart disease |
|
| cerebrovascular disease |
| drug toxicity |
| metabolic disorders |
| migraine |
| sleep disorders |
|
| Main differential of the Nonepileptic Psychologic Events
| anxiety |
| depression |
| malingering |
| panic attacks |
| psychogenic “seizures" |
| psychosis |
|
|
| 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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