Editorial

Chadwick report upon a series of 13 patients in 'pseudostatus epilepticus'. By this is meant prolonged or recurrent convulsions, or other disturbances of consciousness which are simulated. One patient had been admitted 80 times in 10 years, and another 69 times in 14 years. Treatment directed along the lines that the seizures were really epileptic had resulted in a respiratory arrest due to intravenous medication in eight out of the 13 patients on at least one occasion. The paper by Howell and colleagues gives us the opportunity of briefly reviewing the concept of pseudoseizures, the management of which forms a substantial part of the workload of any specialized epilepsy service. The term pseudoseizures is preferred to psychogenic seizures, as true epileptic seizures can in occasional patients be generated by an act of will, or by specific patterns of thought, or by particular emotions. My colleague Peter Fenwick [1] has described a patient with true temporal lobe epilepsy who could often induce a seizure by intensifying feelings of sadness and self pity. Pseudoseizures are simulated. That is to say, they are an act of abnormal behaviour not accompanied anywhere in the cortex or subcortical structures by paroxysmal neuronal discharges, the hallmark of true epilepsy