Imagine coming home at night after excessive partying, and finding yourself unable to unlock your front door. One possibility is that you are at the wrong house; another is that you are using the wrong key; and a third that you really are locked out - perhaps someone inside has engaged the deadbolt. Refractory epilepsy displays three similar categories.

An incorrect diagnosis of epilepsy, going to the wrong house, is more common than most people might think. One chart review study by Smith and colleagues in England (1) concluded that 13% of patients referred for refractory epilepsy did not have epilepsy. If seizures are not controlled, then a reasonable first question is: “Are the episodes really seizures?” A large number of conditions can imitate seizures. Some, but certainly not all, are listed in Table 2.

Experienced clinicians are skilled at using a combination of the medical history, the physical exam and selected laboratory tests to determine whether sudden episodes with alteration in sensation, strength, behavior or awareness are seizures or one of the imitators. But sometimes this determination is difficult. People have been referred to epilepsy centers for brain surgery, when their underlying condition was not epilepsy, but one of the imitators. Further information on imitators of epilepsy can be found in the video series on epilepsy.com (2).

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Topic Editor: Robert S. Fisher, MD, PhD
Last Reviewed: April 21, 2009