Holzer and Bear are quite right in their reminder that the electroencephalograph (EEG) often does not reveal ictal activity during simple partial seizures. Therefore, if our patients with pseudoseizures had shown clinical signs similar only to simple partial seizures, the lack of EEG changes would not have been diagnostic. However, none of our patients had simple partial seizure-like behavior.Eight of our 10 patients had grand mal seizure-like clinical behavior, most of them with "postictal" unresponsiveness, during all of which the EEG continued to show perfectly normal background activity. The diagnosis of pseudoseizures was unarguable.Two of the 10 patients had unresponsiveness similar to the behavior seen in complex partial seizures. Again, the EEG showed no change during the attacks. Only 5% of genuine complex partial seizures are generally thought to show no alterations on scalp EEGs.1We believe that the diagnosis of pseudoseizures in our patients
Bergen DC, Ristanovic R. Epilepsy and Weeping-Reply. Arch Neurol. 1994;51(10):974. doi:10.1001/archneur.1994.00540220019008
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