Differential, Delayed and Dual Seizures-“3D Seizures”

Since historical times, hysteria has colored the literature from novels to movies. The nomenclature changed from hysteria to dissociation over time. With More reliable diagnostic tools being available it became easier to objectively identify this phenomenon. However clinical examination still appears to be the sole diagnostic approach due to ambiguity in results of widely used investigations like EEG and MRI. Pseudo-seizures constitute about 25% of total patients of hysteria and 20% of patients referred to epilepsy centres. There is wide overlap between two diagnoses. Also possibility of differential diagnosis needs to be ruled out before labeling a case with seizures or PNES. Relying long time on particular diagnosis clinically without undergoing available investigations can complicate whole scenario. Author highlights the importance of differential, delayed and dual diagnosis of Pseudo-seizures and paucity of available possible tools to diagnose Pseudo-seizures.