A great variety of epileptic presentations can meet DSM-IV criteria for schizophrenia, brief psychotic disorder, panic attack, generalized anxiety, major depressive disorder, dissociative disorders, dementia, and other conditions under the umbrella of “mental health disorders.” According to set criteria, the symptoms cannot be caused by a general medical condition, but the mimicry of epilepsy syndromes can be so convincing, that seizure may not be even considered.
The increasing frequency of case reports suggests that the number of misdiagnoses are not necessarily declining and there are many yet to be discovered. Additionally, epilepsy and psychiatric disorders are not mutually exclusive diagnoses and could easily coexist. Overlooking either diagnosis in a patient afflicted with both may lead to treatment failures.
The outpatient EEG is not a sensitive test since seizure activity is typically episodic, subtle abnormalities can be easily missed, and imaging is commonly unremarkable. Clinicians must rely on their knowledge of varied presentations to consider epilepsy and whether investigations and consultation with the professionals in other subspecialties are warranted. In difficult cases, referral to an epilepsy monitoring unit for cEEG and video recordings are essential to increase the sensitivity and specificity of the diagnosis. DSM V, to be released in the near future, should identify typical seizure characteristics as exclusion criteria.
Finally, greater collaborations between the disciplines of neurology and psychiatry are required to improve the care for patients that share some characteristic features of the both illnesses but they do not exclusively fall in one or the other camp.
