[Seven cases of pseudoseizure unnecessarily treated with AEDs]

An increasing number of pseudoseizures and/or behavioral abnormalities are being unnecessarily treated with anti-epileptic drugs (AEDs) for long periods, often producing adverse effects and even aggravating abnormal behaviors. Seven of the 77 new referrals (43 men, 34 women) to our epilepsy clinic within a single year (1992-1993) were misdiagnosed with epilepsy and had pseudoseizures or behavioral abnormalities alone. The initial episodes for which AEDs had been given were febrile convulsions during childhood in two patients, nonfebrile convulsions of uncertain nature in four patients, and learning difficulty with EEG abnormality in one patient. The reasons AED treatment had continued for so long are probably the persistence of behavioral problems and/or EEG abnormalities and failure to reevaluate the patients to determine whether they had true epileptic symptomatology. Based on the results of this study, we concluded that: 1. AED treatment should be initiated only after a suspicious episode had been demonstrated to be truly epileptic in nature. 2. The diagnosis of pseudoseizures should be made on the basis of careful investigation of clinical symptomatology and ictal pattern as described in "Proposed International Classification of Clinical and Electroencephalographic Epileptic Seizures, 1981". 3. In doubtful cases, frequent reevaluation of the nature of the episodes and the necessity of AEDs is needed to avoid adverse effects.