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[Munchausen syndrome by proxy: report of one case with epilepsy]
A Fernández-Jaén1, A Martínez-Bermejo, V López-Martín
1Servicio de Neurologia Pediátrica, Hospital Universitario La Paz, Madrid, España.
Introduction:
Munchausen syndrome by proxy (MSBP) is a rare form of child abuse in which a parent, usually the mother, fabricates or produces illness in a child, so causing them unnecessary medical investigations, treatments and hospitalizations. One of the commonest false presenting symptom is 'seizures'.
Clinical Case:
An eight years old boy with Munchausen syndrome by proxy is reported. This child had had genuine seizures well controlled by standard anticonvulsant treatment at the start of the false illness. At the age of seven years, the patient showed very frequent seizures. The child was treated with antiepileptic drugs, but treatments were ineffective and seizures continued. Results of multiple tests, including an extensive blood chemistry analyses, CT, MRI, SPECT, were normal. Electroencephalogram showed posterior slow waves. Acute neurological deterioration was observed six weeks after hospitalization and it was finally proved that seizures were caused or triggered by clomipramine poisoning given by her mother.
Conclusions:
MSBP frequently presents as epileptic seizures in these abused children. MSBP diagnosis is more difficult to be made if true seizures exists with multiple fictitious seizures. Pediatrician should be alerted to the possibility of MSBP when seizures are poorly controlled, treatments are ineffective and there is no neurophysiologic dysfunction. Early diagnosis and intervention are essential because high mortality and psychologic morbidity are associated with this syndrome.
Insights
Munchausen syndrome by proxy (MSBP) can present as seizures in children. This case highlights the difficulty in diagnosing MSBP when genuine seizures coexist with fabricated ones, emphasizing the need for clinical suspicion.
Area of Science:
- Pediatrics
- Child Abuse
- Neurology
Background:
- Munchausen syndrome by proxy (MSBP) is a rare form of child abuse where a caregiver fabricates or induces illness in a child.
- Seizures are a common presenting symptom in children with MSBP, often leading to extensive medical evaluations.
- Distinguishing between genuine and fabricated seizures is crucial for accurate diagnosis and intervention.
Observation:
- A case report of an 8-year-old boy with MSBP is presented.
- The child experienced frequent, genuine seizures that were poorly controlled by standard antiepileptic drugs.
- Extensive diagnostic tests, including neuroimaging and EEG, were inconclusive, while clomipramine poisoning by the mother was identified as the cause.
Findings:
- MSBP diagnosis is challenging when true seizures are present alongside fictitious ones.
- Ineffective treatment for poorly controlled seizures and lack of neurophysiologic dysfunction should raise suspicion for MSBP.
- Clomipramine poisoning was identified as the cause of the child's seizures in this case.
Implications:
- Pediatricians must maintain a high index of suspicion for MSBP in cases of poorly controlled or unexplained seizures.
- Early diagnosis and intervention in MSBP are critical due to the associated high mortality and psychological morbidity.
- Awareness of MSBP's presentation as seizures is vital for protecting child welfare and preventing unnecessary medical interventions.