Nonepileptic seizures: diagnosis and management

Nonepileptic seizures are disorders that are mistaken for epilepsy. They may be caused by physiologic or psychological disturbances but, unlike true epilepsy, nonepileptic seizures are not the consequence of abnormal electrical discharges in the brain. Nonepileptic seizures related to psychological causes are termed "nonepileptic psychogenic seizures" and account for approximately 20% of all intractable seizure disorders. These seizures are often misdiagnosed as true epilepsy, resulting in inappropriate, ineffective, and costly treatment of many patients. Clinical observation has long been the basis for distinguishing nonepileptic from epileptic seizures. Recent advances in video-EEG monitoring have tremendously improved the ability of experienced epilepsy specialists to correctly distinguish nonepileptic seizures from epilepsy, but access to epilepsy experts and comprehensive epilepsy monitoring centers remains limited for many patients. Moreover, even after a correct diagnosis is made a high proportion of such patients continue to have seizures and serious disability. Recent evidence suggests that patients with nonepileptic seizures may benefit from structured treatment programs and extended support from epilepsy centers. As knowledge about the nature of psychogenic seizures and their associated psychopathology is gained, better treatment strategies can be developed that will improve the care and prognosis of these difficult and challenging patients.