[Separation/Conversion Disorders in Functional Coma With Pseudocataplexy: Report of One Case and Literature Review]

Area of Science:

• Neurology
• Sleep Medicine
• Psychiatry

Background:

• Separation/conversion disorders manifesting as functional coma with pseudocataplexy are exceptionally rare clinical presentations.
• Accurate diagnosis is crucial as this condition is often misdiagnosed, necessitating differentiation from true coma and other episodic sleep disorders.

Observation:

• A young female patient presented with episodic consciousness disorders, syncope, and urinary incontinence, with initial neurological and imaging tests yielding normal results.
• Polysomnography and multiple sleep latency tests revealed electroencephalogram (EEG) alpha rhythm and increased muscle tone during unresponsive periods, indicating wakefulness despite apparent coma.
• Elevated cerebrospinal fluid (CSF) orexin levels (>110 pg/mL) excluded episodic sleep disorders, leading to a diagnosis of functional coma with pseudocataplexy.

Findings:

• The patient demonstrated responsiveness to stimuli only during specific sleep stage transitions (N3 to N2), suggesting a unique pattern of altered consciousness.
• Standard pharmacological treatments were ineffective, but significant symptom improvement and sustained remission were achieved after lifestyle modifications including routine adjustment and mood management.

Implications:

• This case underscores the diagnostic challenges posed by functional coma with pseudocataplexy, emphasizing the need for comprehensive sleep studies and CSF analysis.
• Non-pharmacological interventions, such as lifestyle and mood adjustments, can be highly effective in managing functional coma with pseudocataplexy, offering a promising therapeutic avenue.