The differential diagnosis of generalized seizures and psychogenic-seizure-like spells is one of the common and difficult problems a clinical neurologist encounters. The electroencephalogram, unfortunately, does not always solve the problem. Furthermore, evidence that a patient has emotional problems does not necessarily rule out epilepsy. The problem may be particularly difficult in military service, where witnesses of a patient's spells may be thousands of miles from the hospital to which he has been transferred.
It is most important to differentiate psychogenic-seizure-like episodes from seizures. The patient with psychogenic episodes which are mistakenly diagnosed as true convulsive seizures may undergo unnecessary diagnostic procedures, be deprived of appropriate psychiatric treatment, continue to have spells in spite of anticonvulsant medication, and, because of his apparent uncontrolled seizure problem (along with his personality disturbances), become a "thorn in the side" of the neurologist. In the military service he may be medically retired and compensated for
COLLINGS H. Recall with Amobarbital (Amytal) Sodium in Diagnosis of Seizures. AMA Arch NeurPsych. 1958;80(4):408–413. doi:https://doi.org/10.1001/archneurpsyc.1958.02340100008002
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