Neurologist, 29 years’ experience, USA

Abstract

This chapter details how patients with Psychogenic Non-Epileptic Pseudoseizures present some of the more challenging cases brought to a specialist in clinical epilepsy or neurophysiology. One particular case taught a neurologist several important points about the evaluation of those who have psychogenic symptoms. First, an unreliable history is a finding. Second, examination techniques may help separate physiological from functional deficits. Third, despite these careful observations, the patient may not appreciate the efforts. The chapter then specifically looks at a case where a woman presented to the epilepsy monitoring unit with a several year history of paroxysmal events consisting of a metallic taste, bilateral scintillating scotomas, left arm posturing, and loss of consciousness with shaking. Postictal symptoms consisted of headache, amnesia, and severe fatigue. Injuries were also common. In fact, she had been intubated at least twice for status epilepticus. She was also deaf. Later, the neurologist found out that the patient had a history of sexual abuse and had seen a psychiatrist in the past for posttraumatic stress disorder (PTSD). The neurologist thus considered her history as unreliable.