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NEUROLOGY 1990;40:1404
© 1990 American Academy of Neurology

Supplementary motor seizures mimicking pseudoseizures

Some clinical differences

A. M. Kanner, MD, H. H. Morris, MD, H. Lüders, MD, PhD, D. S. Dinner, MD, E. Wyllie, MD, S. Q. Medendorp, MPH and A. J. Rowan, MD

From the Section of Epilepsy and Clinical Neurophysiology (Drs. Kanner. Morris, Lüders, Dinner, and Wyllie) and the Department of Biostatistica and Epidemiology (S.V. Medendorp), Cleveland Clinic Foundation, Cleveland, OH and the Department of Neurology (Dr. Rowan), Bronx VA Medical Center and Mount Sinai School of Medicine, New York, NY.

Supplementary motor seizures (SMS) are among the group of frontal lobe seizures that may often be misdiagnosed as pseudoseizures (PS). We designed this study to determine the value of clinical phenomena in distinguishing between the two. In a series of patients with SMS, we identified those with signs and symptoms mimicking PS and compared the clinical phenomena with those of clinically similar PS. We found that SMS are short in duration, stereotypic, tend to occur in sleep, and often present with a tonic contraction of the upper extremities in abduction. This sign was specific for SMS, particularly when occurring at the onset. Conversely, PS are long in duration, nonstereotypic, and occur in the awake state. We conclude that clinical phenomena may be useful in distinguishing PS from SMS, although the final diagnosis must be documented by neurophysiologic means.

Address correspondence and reprint requests to Dr. Andres M. Kanner, Department of Neurology, University of Wisconsin Hospital and Clinics, Room H4/616, 600 Highland Avenue, Madison, WI 53792.

Presented in part at the 40th annual meeting of the American Academy of Neurology, Cincinnati, OH, April 198bt.

Received March 20, 1989. Accepted for publication in final form March 9, 1990.




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