SHM Converge Scientific Abstract ePoster Gallery-Decoding Dual Diagnosis: Psychogenic Non-Epileptic Seizures and Epilepsy in Challenging Clinical Presentations

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This case highlights a diagnostically complex patient with neuropsychiatric systemic lupus erythematosus (NPSLE) who developed persistent seizure-like episodes. Although her NPSLE was treated, the events continued, raising concern for an additional seizure disorder. Evaluation showed MRI findings of mild-to-moderate brain atrophy with patchy periventricular and subcortical hyperintensities suggestive of inflammatory change. Lumbar puncture ruled out meningoencephalitis.<br /><br />A key feature of the case was the presence of both psychogenic non-epileptic seizures (PNES) and clinically apparent seizure-like episodes, making this a rare dual diagnosis. This distinction was especially important because the patient had altered mental status and limited historical information, which complicated clinical interpretation.<br /><br />To clarify the diagnosis, prolonged video EEG monitoring was performed. Three separate 24-hour vEEGs showed no epileptic activity, even though the patient had postictal-appearing states and tongue lacerations. Video EEG also demonstrated normal sleep architecture, including stage II sleep with K complexes and sleep spindles, but no ictal or interictal epileptiform patterns and no captured clinical events.<br /><br />Overall, this case emphasizes the importance of EEG, particularly prolonged vEEG, in differentiating epilepsy from PNES in patients with autoimmune disease and seizure-like episodes. It also shows that persistent episodes after treatment of NPSLE do not necessarily indicate ongoing epileptic activity, and careful diagnostic evaluation is essential for accurate management.

Asset Subtitle

Marwah Shuaib

Meta Tag

Author List Hufsa Khan, Marwah Shuaib, Niharika Chandna, Peter Caldwell

Category Clinical Vignettes

Concept Psychogenic Nonepileptic Seizure

Concept Epileptic Seizure

Concept Neuropsychiatric Systemic Lupus Erythematosus

Concept Video Electroencephalography

Distinguished Non-Finalist

Presenter Organization George Washington University Hospital

Presenting Author Marwah Shuaib

Track Adult

Keywords

neuropsychiatric systemic lupus erythematosus

NPSLE

psychogenic non-epileptic seizures

PNES

seizure-like episodes

video EEG monitoring

prolonged vEEG

epilepsy differential diagnosis

autoimmune disease

brain atrophy

Psychogenic Nonepileptic Seizure

Epileptic Seizure

Neuropsychiatric Systemic Lupus Erythematosus

Video Electroencephalography