Sir, I would like to highlight to the readers the importance of awareness of the 'pseudoseizure' patient in the surgical setting.

Pseudoseizures are paroxysmal episodes that often resemble epileptic seizures, but are psychological in origin. Stressful situations such as surgery under local anaesthetic are well known potential triggers of these episodes.

A 58-year-old Iraqi lady attended the maxillofacial department for the routine extraction of a tooth under local anaesthetic. The extraction was carried out without incident.

Ten minutes post-extraction I was urgently called to see the patient who had collapsed in the hospital stairwell. On inspection the patient was lying on the floor moaning, crying and exhibiting bizarre asynchronous movements. Her vital signs remained normal as she waxed and waned between periods of lucid normality and paroxysmal seizures. The on-call anaesthetist was summoned and supportive care was given in the anaesthetic recovery area until the pseudoseizures had completely subsided.

Good awareness of how to manage a pseudoseizure is vital to the surgeon, particularly when operating under local anaesthetic. These events can be extremely stressful for the patient, the patient's family and the dentist. Noting risk factors such as a history of abuse or trauma, or previous 'bad reactions to local', and recognising clinical features that differentiate pseudoseizures from epileptic seizures is vital. If the seizure-like episode persists or worsens experienced help should be sought without delay.