Temporal Lobe Seizures Presenting as Abrupt Clinging Behavior in a Child

Area of Science:

• Neurology
• Pediatrics
• Psychiatry

Background:

• Psychogenic nonepileptic seizures (PNES) are often underdiagnosed in children compared to adults.
• Distinguishing true epileptic seizures from PNES can be challenging due to overlapping and varied clinical presentations.

Observation:

• A 9-year-old boy presented with dramatic, episodic behavioral changes resembling psychogenic phenomena, including La-Belle indifference, without loss of consciousness.
• Initial presentation suggested a psychogenic origin, leading to potential misdiagnosis.

Findings:

• The patient was ultimately diagnosed with temporal lobe epilepsy.
• The seizures responded dramatically to antiepileptic drug treatment, confirming the organic etiology.

Implications:

• This case underscores the importance of considering epilepsy in children presenting with unusual episodic behaviors, even when they mimic PNES.
• Clinicians should maintain a high index of suspicion for rarer epilepsy presentations and conduct thorough, holistic assessments to avoid misdiagnosis.
• Accurate diagnosis is crucial for effective management and treatment of pediatric epilepsy.