[Epilepsy or functional neurological disorder. Diagnostic strategies]

Area of Science:

• Neurology
• Clinical Neuroscience

Context:

• Seizures are neurological events caused by abnormal synchronous neuronal activity.
• Epilepsy diagnosis is considered after a single unprovoked seizure with high recurrence risk.

Purpose:

• Differentiate paroxysmal non-epileptic disorders (PNEDs) from epileptic seizures.
• Highlight the high incidence of PNEDs and their varied origins.
• Emphasize diagnostic accuracy to prevent overdiagnosis of epilepsy.

Summary:

• PNEDs mimic epileptic seizures but arise from diverse brain dysfunctions, not excessive neuronal discharge.
• PNEDs have a higher incidence than epilepsy and can occur at any age.
• Diagnostic evaluation involves triggers, episode details, physical exams, and judicious use of tests like video-electroencephalogram.

Impact:

• Reducing the overdiagnosis of epilepsy and the overuse of anticonvulsant medications.
• Improving diagnostic accuracy for conditions mimicking seizures, such as syncope, 'daydreams,' and pseudoseizures.
• Enhancing patient care by distinguishing between epileptic and non-epileptic events.