Psychogenic Seizure Imitating Narcolepsy

Area of Science:

• Neurology
• Neuroscience

Background:

• Functional neurological disorders (FND) are common in neurology practice, posing diagnostic difficulties.
• Psychogenic non-epileptic seizures (PNES) constitute approximately 40% of FND cases.
• Differentiating PNES from other conditions like narcolepsy is clinically significant.

Observation:

• A 55-year-old man presented with frequent, brief, sleep-like attacks and nocturnal disturbances.
• Attacks involved unresponsiveness, snoring, maintained posture, resisted eye opening, and post-attack confusion.
• Interictal FND signs included give-way weakness, functional gait disturbance, and impaired finger-to-nose testing.

Findings:

• Video-electroencephalogram (VEEG) monitoring revealed no epileptic activity or specific sleep patterns during attacks.
• Polysomnography (PSG) and multiple sleep latency test (MSLT) excluded narcolepsy.
• PNES presentation evolved, becoming less pronounced after the patient received disability benefits.

Implications:

• This case underscores the diagnostic complexity of PNES, particularly when mimicking sleep disorders like narcolepsy.
• The observed changes in PNES symptoms following disability benefit suggest a significant psychogenic influence.
• Recognition of FND and PNES is crucial for accurate diagnosis and appropriate patient management.