[True or pseudo epilepsy in the adult]

THE EXTENT OF THE PROBLEM: A patient can be misleadingly considered as epileptic although he is not. Conversely an epileptic man not be recognised as such. Moreover, in some patients epilepsy seizures may co-exist with pseudo-seizures. THE PROBLEMS IN DIAGNOSIS: Each stage of the diagnosis of epilepsy is limited, whether regarding anamnesis, electroencephalogram, not only standard but also video, or even the semiological analysis because of the clinical polymorphism of partial epileptic seizures. THE MAJOR DIFFERENTIAL DIAGNOSES: Migraine with aura may be difficult to differentiate from occipital attacks with visual hallucinations. Bilateral tonic or chronic phenomena may occur during syncope. A partial epileptic seizure may simulate a cerebral vascular stroke. Paroxistic anxiety (panic attacks) can resemble that observed during partial seizures with vegetative semiology. In fact the problem is dominated by the pseudo-epileptic seizures, the diagnosis of which is evoked on the clinical aspect, the mode of onset, the past history of the patient and confirmed by simultaneous EEG video recording. FROM A THERAPEUTIC POINT OF VIEW: The best action is preventive. It consists in the earliest possible detection of the pseudo-epileptic seizures and in avoiding so-called 'test' treatments.