Table 3

Some paediatric psychological disorders that may mimic seizures

DisorderDifferentiation from epileptic seizures
Panic attacks (PA)
  • Can mimic focal seizures such as those arising from the temporal lobe

  • The distinction is usually made by appreciating that PAs tend to be situational, and have a protracted course

Episodic dyscontrol syndrome
  • Violent uncontrollable aggression against an individual with or without provocation

  • ‘Ictal aggression’ is rare, and is usually primitive, stereotyped and not directed against a certain person. It is commonly associated with other seizure types

Unusual psychological experiences:
  • Depersonalisation (uncomfortable sense of unreality concerning one's self)

  • Derealisation (uncomfortable sense of unreality concerning one's environment)

  • May mimic epileptic aura

  • Epileptic auras are usually short, and may be followed by ictal stereotyped motor behaviours

Hallucinations in psychiatric disorders
  • These are usually complex as opposed to being elementary in focal seizures (eg, hearing voices of people vs hearing buzzing sounds)

  • In epileptic seizures, there is an interval of normality

Acute drug or alcohol intoxication
  • The history can be suggestive, but not always

  • Appropriate laboratory work up as indicated