Pseudoseizures simulating status epilepticus: Two cases of over-treatment in the emergency department and pediatric intensive care unit

Pseudoseizures (PS) resemble epileptic seizures. They are strictly linked to personality disorders and may involve all ages, with a higher incidence during adolescence. Patients experience episodes of loss of consciousness, twitching or jerking, and unusual emotional states, such as intense feelings of fear or "déjá vu". The episodes may last 20 minutes, but unlike epileptic seizures, they are not associated with electrical abnormalities in the brain. Even for trained medical professionals, differentiating epileptic seizures from PS is difficult. Physicians believe PS are psychological defense mechanisms induced by stress or episodes of severe emotional trauma; in fact, they tend to occur when patients try to avoid or forget the trauma. Twenty percent of patients with seizures are ultimately diagnosed with PS but the diagnosis is difficult to make on the first examination. Patients with PS are often referred to the Emergency Department because of their poor response to conventional anticonvulsant drugs. Due to the apparently critical condition of these patients on presentation, they are often referred to a Pediatric Intensive Care Unit (PICU) and may be over-treated during their difficult and long diagnostic course. We report two cases admitted to our PICU for apparent status epilepticus, in which the final diagnosis was PS.