When the Brain and the Heart Collide: A Complex Diagnostic and Management Dilemma of Coexisting Psychogenic Nonepileptic Seizures and Takotsubo Cardiomyopathy - A Case Report

Abstract

Epilepsy is a prevalent neurological disorder affecting around one percent of the global population. Accurate diagnosis is paramount for effective treatment, but challenging-to-diagnose seizures require a comprehensive evaluation to exclude other conditions. Psychogenic nonepileptic seizures (PNES) or pseudoseizures are sudden episodes resembling epileptic seizures, but not arising from abnormal cerebral electrical activity. PNES are often misdiagnosed as epilepsy, leading to delayed appropriate psychological therapy and unwarranted antiepileptic medication use. We report a unique case of a patient initially diagnosed and treated as epilepsy, who was later diagnosed with PNES during hospitalization. Additionally, the patient presented Takotsubo cardiomyopathy (TCM), a rare stress-induced cardiomyopathy, posing a diagnostic and management challenge alongside PNES. To the best of our knowledge, this is the first case of coexisting PNES and TCM, which warrants further investigation.