Rhytmic Mid-Temporal Discharges in a Mother and Daughter with Psychogenic Non-Epileptic Seizures

Psychogenic non-epileptic seizures (PNES) are complex episodes that outwardly resemble epileptic seizures but are not caused by any underlying neurological disease. Unlike true epileptic seizures, PNES are more likely to be linked to psychological factors and do not show any abnormal activity on electroencephalography (EEG) recordings. This differentiation is crucial for accurate diagnosis and treatment, as misdiagnosing can lead to unnecessary treatments.Diagnosis of PNES might become difficult in the presence of particular benign EEG variants such as Rhythmic Midtemporal Discharges (RMTD). RMTD is a rare benign variant of normal EEG, characterized by rhythmic 5-7 Hz discharges in the temporal regions. This pattern could be present in normal individuals, in patients with psychiatric disorders or epilepsy. It could mimic interictal epileptiform discharges. Recognition of this pattern is essential to avoid misinterpretation of EEG findings that might eventuate in inappropriate treatment and adverse effects on a patient's medical condition, especially when there is a recent suspicious event in terms of an epileptic seizure. Among patients with PNES, the occurrence of benign variants might be much harder to interpret and physicians may mistakenly interpret RMTD on the EEG as indicative for epilepsy, especially in the absence of clear clinical criteria for PNES. This report is the first to document RMTD in first-degree relatives with PNES, suggesting a possible genetic predisposition and the need for further research into the interaction between RMTD and PNES.Our aim is to raise awareness that will enable accurate EEG reading and correct diagnosis.