Bergen and Ristanovic1 provide important information regarding the manifestations of pseudoseizure ("Weeping as a Common Element of Pseudoseizures"). However, we believe that their conclusions are premature.
While paroxysmal motor or sensory disturbances accompanied by alterations in the level of consciousness are easily recognized symptoms of seizures, a range of subtle behavioral and psychiatric presentations of epilepsy may also occur, primarily in the setting of simple partial seizures. During a simple partial seizure in which a psychiatric symptom is displayed, the epileptic origin may not be apparent, as the patient is conversant and has recall for ongoing events. Psychiatric and behavioral manifestations often result when neocortical and limbic structures are activated within the temporal lobe or orbital prefrontal cortex; these are the most common origins for partial seizures.2,3 Routine electroencephalographic monitoring with scalp electrode placement is remarkably insensitive in detecting seizure activity in such limbic regions. Recent studies4
Holzer JC, Bear DM. Epilepsy and Weeping. Arch Neurol. 1994;51(10):973–974. doi:10.1001/archneur.1994.00540220019007
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