Psychogenic non-epileptic seizures: a case report

Psychogenic Non-Epileptic Seizures (PNES) are paroxysmal episodes of altered behavior that superficially resemble epileptic seizures but lack both the expected electroencephalographical epileptic changes and the association to dysfunction of central nervous system. They account for 17 to 30% of the population admitted to epilepsy units of tertiary hospitals for evaluation of seizures refractory to the pharmacological treatment. These episodes include most of the paroxysmal non-epileptic events and diverse studies have found a high prevalence of multiple psychiatric disorders during the lifetime. The simultaneous presence of 2 or more psychiatric disorders has even been observed in 70% of the patients. When there is evidence on the absence of real epileptic seizures, the first step is to slowly suppress the antiepileptic treatment. After, adequate psychopharmacological treatment should be initiated in relationship with the psychopathological state of the patient. The different emotional and psychological variables that may be affecting the appearance and perpetuation of PNES must be identified and then resolved with psychological treatment. The aim of the present case report is to present the difficulties of differential diagnosis between epilepsy and PNES, emphasizing the great importance of both neurological and psychiatric management in the treatment of these clinical symptoms.