Evaluation of childhood pseudoseizures using EEG telemetry and video tape monitoring.

Pseudoseizures, clinical events that superficially resemble epileptic attacks but which are not associated with central nervous system paroxysmal activity, are often difficult to differentiate from epileptic seizures. To evaluate the frequency and clinical manifestations of pseudoseizures in children with intractable seizures, children admitted to a Comprehensive Epilepsy Unit received prolonged simultaneous EEG telemetry and video recording. Pseudoseizures occurred in 11 of 53 pediatric patients admitted during the study period. Eight of the 11 patients with pseudoseizures also had documented epileptic seizures. Clinical characteristics of pseudoseizures and epileptic seizures documented by TEEG-VR were compared. Degree and duration of the postictal state, incontinence, combativeness, relationship to stress, and response to anticonvulsant medication were useful differentiating criteria. Pseudoseizures are not unusual in pediatric patients, often occur concurrently with epileptic seizures, and may be difficult to diagnose. However, careful clinical observation may offer clues in differentiating pseudoseizures from epileptic seizures.