In order to determine how often results of video/EEG (V-EEG) studies may ch
ange the clinical diagnosis of paroxysmal events, we prospectively studied
100 consecutive patients (75 females, 25 males) admitted for diagnosis of r
ecurrent paroxysmal spells. The presumed diagnosis of the referring physici
an was obtained. Episodes were classified as epileptic seizures (ES), psych
ogenic non-epileptic events (PNEE), or physiologic non-epileptic events (Ph
ysNEE). Eighty-seven patients had diagnostic events. A final diagnosis of E
S was made in 21 patients, PNEE in 39, PNEE + ES in 20, and PhysNEE in seve
n. All PhysNEE were unsuspected. ES were misdiagnosed as PNEE more frequent
ly than the reverse (57% vs. 12%, P < 0.001). Among the 64 patients with re
corded events who had been suspected of having PNEE, 14 (21.9%) were misdia
gnosed: two had PhysNEE and 12 (18.75%) had ES. Among the 23 patients with
recorded events who were thought to have ES, 12(39.1%) were misdiagnosed: s
even had PNEE, five PhysNEE. V-EEG changed the clinical diagnosis in 29.8%
of the patients with recorded events. Our data suggests that clinicians hav
e become more aware of PNEE since the advent of V-EEG and have little probl
em recognizing them. However, they may be more prone to make a false-positi
ve diagnosis of PNEE in ES with some atypical features. At this point, effo
rts should be channeled to better training in the proper recognition of ES
that mimic PNEE.