Postgrad Med J 81:498-504 doi:10.1136/pgmj.2004.029785
  • Review

The approach to patients with “non-epileptic seizures”

  1. J D C Mellers
  1. Correspondence to:
 Dr J D C Mellers
 Department of Neuropsychiatry, Room 32, Outpatient Department, Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK
  • Received 15 October 2004
  • Accepted 14 December 2004


Up to one fifth of patients who present to specialist clinics with seizures do not have epilepsy. The majority of such patients suffer from psychologically mediated episodes; dissociative seizures, often referred to as “non-epileptic seizures”. This paper describes the diagnostic evaluation of seizure disorders, including clinical assessment and the role of special investigations. The organic and psychiatric imitators of epilepsy are outlined and findings on psychiatric assessment are reviewed. This group of patients often proves difficult to engage in appropriate treatment and an approach to explaining the diagnosis is described. As yet there are no controlled trials of treatment in this disorder but preliminary evidence suggests cognitive behavioural therapy is both a rational and promising way forward.


  • Funding: none.

  • Conflicts of interest: none.