This difficulty in differential diagnosis may be confounded by attempts at EEG correlation if ictal activity is confined to deep temporal foci, as with our patient. With multiple events, no change in surface EEG was seen. After several days off medication, a typical event was shown to have an ictal correlate. The automatisms of partial complex seizures and prolonged postictal confusion may also be misdiagnosed as a dissociative state. One possible explanation for the coexistence of the two disorders is that a significant risk factor for both multiple personality disorder and nonelectrical seizures is physical or sexual abuse.
Nonelectrical seizures are likely to occur in patients with concomitant electrical events.
Another possible hypothesis is that the physical abuse, so characteristic in the histories of patients with dissociative disorder, may result in head trauma predisposing to electrocerebral disturbances. A more neuroanatomical explanation is offered by Mesulam. Thus, the diagnosis of temporal lobe epilepsy must be given serious consideration when the patient presents with dissociative disorder. As our case demonstrates, a failure to consider epilepsy in the diagnosis may lead to serious underrecognition of a highly treatable illness. Our patient was evaluated in several epilepsy centers before reaching ours.