Abstract
Nonconvulsive status epilepticus is characterised by changes in behaviour, memory, affect or level of consciousness. We report a case of nonconvulsive status epilepticus precipitated by carbamazepine that presented as dissociative fugue. The patient was a 49-year-old man. He first experienced a tonic-clonic seizure nine years previously and was diagnosed with grand mal epilepsy. He had been using carbamazepine 800 mg daily for the last eight years. He had not had any tonic-clonic seizures since carbamazepine was introduced but began to display behavioural disturbances periodically. He also left home many times, and remembered nothing about the period he had been away after he returned. He was hospitalised with a preliminary diagnosis of dissociative fugue. He had recurrent episodes with dissociative symptoms during his stay in the hospital. An electroencephalogram (EEG) and a 24-hour video EEG revealed nothing abnormal. An EEG recording taken during an episode indicated complex partial status epilepticus. Carbamazepine was substituted with valproate, and the patient was discharged in remission.
Highlights
The relationship between epilepsy and psychiatric disorders has generated interest since ancient times
The recognition of psychiatric disorders has gained much importance in patients with epilepsy, and some psychiatric symptoms are found to be an expression of the seizure disorder.[1]
This paper reports a case of status epilepticus presenting as disso ciative fugue
Summary
Nonconvulsive status epilepticus is characterised by changes in behaviour, memory, affect or level of consciousness. He first experienced a tonic-clonic seizure nine years previously and was diagnosed with grand mal epilepsy. He had not had any tonic-clonic seizures since carbamazepine was introduced but began to display behavioural disturbances periodically He left home many times, and remembered nothing about the period he had been away after he returned. The diagnosis requires a high index of suspicion as well as EEG confirmation.[2] Mood and anxiety disorders are the most frequent psychiatric comorbidities in patients with epilepsy, followed by psychotic disorders and personality disorders.[3] Rarely, typical symptoms of dissociative disorders may occur during epileptic attacks, but among epileptic patients with dissociative symptoms, only a minority have concomittant dissociative disorders.[4] This paper reports a case of status epilepticus presenting as disso ciative fugue
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