Controversies in the diagnosis and management of psychogenic pseudoseizures

Since the advent of video-EEG telemetry studies (V-EEG) neurologists have become increasingly aware of psychogenic pseudoseizures (PPS) given the relatively high prevalence of these events among patients seen in epilepsy centers. The use of V-EEG has been accepted as the gold standard study in establishing this diagnosis; some clinicians, however, have suggested that the clinical phenomena of PPS are so obvious in many patients that V-EEG may not be necessary. This is one of many controversial points that clinicians face when evaluating patients suspected of having PPS. In this article, we review some of these controversies, specifically the need for a video-EEG monitoring study in all patients suspected of having PPS and the role of induction protocols in the evaluation of PPS, the question of whether patients have any control over their events, and finally some of the therapeutic strategies for PPS including the need to limit these patients' driving privileges.