Distinguishing epileptic seizure from non-epileptic seizure is a common diagnostic problem. Neurogenic or cardiac syncope can appear similar to atonic and even convulsive seizures. Classic migraine and transient ischemic attacks may also resemble epileptic seizures. Sleep disorders including REM sleep behavior disorder, nocturnal paroxysmal dystonia, and narcolepsy likewise simulate an epileptic seizure. Movement disorders such as paroxysmal dyskinesia can be misinterpreted as epileptic seizures (reflex epilepsy or myoclonic seizures). Psychogenic seizures are often misdiagnosed as an intractable epilepsy. Prior to the definitive diagnosis of epilepsy, possible non-epileptic seizures should be excluded. For the correct decision, a thorough and systematic history taking is important. In addition, EEG, pseudoseizure induction test, head-up tilt test, EKG, sleep studies, and video-EEG monitoring may be necessary. Misdiagnosis of non-epileptic seizures as epilepsy may result in unnecessary anti-epileptic drug use. At the same time, we should let the patients understand what the epilepsy is and that epilepsy is a treatable disease.
Chorea ; Diagnosis ; Diagnostic Errors ; Drug Resistant Epilepsy ; Electrocardiography ; Electroencephalography ; Epilepsy* ; Humans ; Ischemic Attack, Transient ; Linear Energy Transfer ; Migraine with Aura ; Movement Disorders ; Narcolepsy ; Nocturnal Paroxysmal Dystonia ; REM Sleep Behavior Disorder ; Seizures* ; Sleep Wake Disorders ; Syncope

Nocturnal paroxysmal dystonia is characterized by brief, abrupt, dystonic or dyskinetic movement during NREMsleep. It has been considered as a form of nocturnal frontal lobe epilepsy. A 35-year-old man complained of sleep disturbance and abnormal movement during sleep. In video-polysomnography recordings, he showed frequent stereotyped abnormal dystonic movements in upper and lower extremities. The dystonic movements occurred during stage IV sleep. He was treated with carbamazepine and the symptoms improved. (J Korean Neurol Assoc 19(3):305~308, 2001)
Adult ; Carbamazepine ; Dyskinesias ; Epilepsy, Frontal Lobe ; Humans ; Lower Extremity ; Nocturnal Paroxysmal Dystonia* ; Polysomnography