Nonepileptic (psychogenic or pseudo) seizures (NESs) were documented by video-electroencephalographic monitoring during apparent sleep in 12 patients reported from New York University School of Medicine. Onset was in childhood in 6 patients, and age at testing ranged from 11 to 67 years (mean, 33 yr). In addition to NESs unassociated with ictal EEG changes, 3 patients had EEG interictal epileptiform discharges and 1 had a complex partial seizure during monitoring, distinct from NES. Most NESs occurred within 2 hours of falling asleep or awakening. Provocative testing with suggestion reproduced nocturnal attacks in 9 patients. Seizures reported during sleep are not necessarily epileptic in nature. [1]

COMMENT. One-half of these patients had a history of childhood abuse. Four patients had evidence of epilepsy in addition to NESs.

The differential diagnosis in pseudoepileptic seizures is illustrated by case-reports from the Department of Neurology, University of Virginia Health Sciences Center, Charlottesville, VA [2]. Epilepsy and pseudoepileptic seizures frequently coexist; the combination occurs in 20% before age 10 years and 60% after 10 years. Munchausen’s syndrome often presents as pseudoepilepsy. Frontal lobe seizures have atypical patterns and may masquerade as pseudoseizures; these consist of thrashing, pedaling, kicking, or thrusting movements, an agitated appearance and utterance of loud expletives during sleep.