Non-Epileptic Seizure Case Study

Psychogenic non-epileptic seizure

History:

A 41 year old female was referred to have an EEG due to episodes of twitching of the neck, drooping of the right facial features and blurred vision. These episodes self-terminate in 15 minutes and she then feels weak in her legs. Her husband reports episodes of generalised tonic-clonic seizures with urinary incontinence. She is currently on no medication.

The clinical indication for the test was migraine, syncope or epilepsy.

EEG findings:

The patient was calm, alert and cooperative throughout the recording. The background contains a posterior dominant rhythm at 11Hz alpha activity which was synchronous and reactive to eye opening. There was widespread beta activity intermixed throughout the background recording. (Figure 1)

Figure 1: This illustrates the patient’s background activity. Clinical event:

During Intermittent photic stimulation the patient started

There was no epileptiform activity present on the EEG during the event or in the background. Therefore, this rules out epilepsy. The patient’s husband mistakenly judged her event as a generalised tonic-clonic seizure.

A generalised tonic-clonic seizure is classified by a possible aura, loss of consciousness, loss of posture, tonic phase lasting approximately 10-20 seconds with a slightly longer clonic phase. There is postictal confusion which could last for a few hours. During a generalised tonic-clonic seizure, there will be focal or generalised spikes (typically 3 Hz spike and wave discharge) with a postictal generalised slowing (S. Kahan et al, 2005). During the clinical event, the patient did not show all the typical features of a generalised tonic-clonic seizure. However the presentation was similar and this is why the husband may have mistakenly made the