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
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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