Monthly Case

A 35-year-old female patient suffers from seizures for 10 years. Her disorder commenced during a grievous separation. Seizures are characterized by twitching and beating of all extremities and prominent movements of her trunk and pelvis. These seizures have been diagnosed epileptic 10 years ago. Since then, the patient has regularly taken antiepileptic drugs (at first carbamazepine, now levetiracetam in a dose of 2,000 mg daily). Seizure frequency is 2-3 monthly that is not at all influenced by antiepileptic drugs. The patient herself reports that seizures manifest almost exclusively in situations characterized by stress (e.g. conflicts in her family).

The patient was admitted to the Epilepsy-Center Berlin-Brandenburg by her private neurologist in order to re-assess her seizures due to putative pharmacoresistance.

History already – onset of seizure disorder in the setting of a separation, manifestation of seizures in situations of stress – strongly argues that seizures are not of epileptic but of psychogenic non-epileptic origin. Typical is that seizures occur situational, in contrast epileptic seizures in patients with epilepsy generally manifest unprovoked and unexpected. In a routine EEG, a typical seizure occurred. Semiologically, eyes were closed, motor signs were irregular and undulant. EEG showed movement artifacts, there was no seizure pattern.

We discussed with the patient our diagnostic assessment, levetiracetam was gradually tapered. At the same time, psychotherapy was initiated. The aim was to learn to cope with stressful situations in other ways than permitting development of psychogenic non-epileptic seizures.

Studies have demonstrated that the correct diagnosis of psychogenic non-epileptic seizures is commonly made 7 years after onset. Prior to that patients are administered – with physicians’ assumption of epilepsy – all too often several antiepileptic drugs.

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