Abstract
Psychogenic Nonepileptic Seizures (PNES) are defined as typical seizure-like activities or behaviors without cortical epileptiform discharges. The diagnosis of PNES remains a challenge and continuous video electroencephalography (cEEG) remains the gold standard to differentiate between epileptic seizures and PNES. Despite advances made in our understanding of PNES, diagnosing and treating this well-known entity remains a challenge. 25% of patients with seizures will be misdiagnosed as having PNES or epileptic seizures even by certified Neurologists. Do patient characteristics and demographics increase our accuracy to diagnose PNES? We present a case of a mother and her son, both diagnosed with PNES by cEEG monitoring in our epilepsy monitoring unit. While familial prevalence of conversion disorders is reported in the literature, this will be the first case report describing the incidence of PNES in two members of the same family. Do psychogenic epilepsies run in families? Will the diagnosis of PNES in one family member increase the probability of PNES in their relatives with seizures? Larger patient pools need to be studied to draw a definite conclusion regarding our observation.
Highlights
Psychogenic Nonepileptic Seizures (PNES) are defined as typical seizure-like activities, behaviors or experiences without simultaneous cortical epileptiform discharges [1]
As illustrated by our case above, when a woman in her 3rd or 4th decade develops a conversion disorder such as PNES, the improper defense mechanisms like dissociation can be transferred to her children who progress to develop a similar disorder if they are not counselled or provided with adequate psychological support in a timely manner
And accurate diagnosis of PNES leads to a reduction of emergency visits by 97%, of clinic visits by 80%, of diagnostic testing by 76%, and medication charges by 69%, in the first 6 months, based on the observation by Martin RC et al [27]
Summary
Psychogenic Nonepileptic Seizures (PNES) are defined as typical seizure-like activities, behaviors or experiences without simultaneous cortical epileptiform discharges [1]. Patient endorsed that this witnessed event was typical for his seizure-like episodes His mother carried a diagnosis of epilepsy for 30 years and was seen in our clinic a few years back. After a careful continuous EEG monitoring and implementation of seizure induction techniques, we were able to simulate their typical seizure-like events in an observed setting of an EMU and were able to clearly demonstrate the functional origin of their symptoms. Both of our patients were eventually diagnosed with PNES and were appropriately referred to the PNES clinic for further management. They were successfully taken off AEDs and received behavioral counselling to help them handle stressful situations better
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