ABSTRACT.Involvement of the limbic system, the seat of emotions in the brain, can lead to psychiatric accompaniments to epilepsy. Patients with epilepsy may also have depression, psychoses, forced normalization, and personality disorders. Long-term video/EEG has allowed improved differentiation between epileptic syndromes and nonepileptic disorders that may mimic epilepsy clinically. Pseudoseizures are important nonepileptic events that need to be distinguished from epileptic seizures. Other conditions that may accompany epilepsy or be confused with epileptic seizures include migraine and the MELAS syndrome; sleep disorders, such as cataplexy, sleep attacks, and REM sleep behavior disorder; the childhood disorders of breathholding spells, benign paroxismal vertigo of childhood, and Rett syndrome; and movement disorders such as shuddering spells and hyperekplexia.