SHM Converge Scientific Abstract ePoster Gallery-Psychogenic Non-Epileptic Seizures: Formulating a Differential Diagnosis

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This case report highlights the difficulty of diagnosing psychogenic non-epileptic seizures (PNES), which can closely resemble epileptic seizures, acute dystonia, or vasovagal syncope. PNES often lead to misdiagnosis because symptoms may appear neurologic, yet the underlying cause is psychological rather than structural or epileptic. This can result in unnecessary and potentially harmful interventions, including excessive benzodiazepine use, intubation, and repeated hospital admissions.<br /><br />The case describes a 32-year-old woman with generalized anxiety disorder and major depressive disorder who presented to the emergency department after multiple seizure-like episodes. She was initially treated with Ativan, Keppra, and Benadryl, and her symptoms temporarily improved, which made acute dystonia a consideration. However, she then had another episode with a different posture and atypical pattern. Her labs, CT, MRI, and EEG were all normal, making an organic seizure disorder less likely.<br /><br />Further history revealed that two days earlier she had discussed a prior sexual abuse experience during therapy, which triggered a strong emotional reaction. Soon afterward, she developed eye twitching and progressive shaking that spread from the lower to the upper extremities. Given the normal medical workup and the psychological trigger, she was diagnosed with PNES.<br /><br />The report emphasizes that when the medical evaluation is unremarkable, clinicians should carefully explore psychiatric history and trauma exposure to help distinguish PNES from other causes of seizure-like activity. Once diagnosed, the condition should be explained sensitively, antiseizure medications should be tapered when appropriate, and psychiatric comorbidities should be addressed. Cognitive behavioral therapy is the most commonly used first-line treatment, although evidence for other therapies remains limited.

Asset Subtitle

Karan Rajalingam

Meta Tag

Author List Denis Babici, Karan Rajalingam, Marc Swerdloff, Phillip M. Johansen

Category Clinical Vignettes

Concept Psychogenic Nonepileptic Seizure

Concept Epileptic Seizure

Concept Electroencephalography

Concept Clinical Presentation

Concept Atypical Seizure Pattern

Distinguished Non-Finalist

Presenter Organization Florida Atlantic University

Presenting Author Karan Rajalingam

Track Adult

Keywords

psychogenic non-epileptic seizures

PNES

seizure-like episodes

misdiagnosis

acute dystonia

vasovagal syncope

benzodiazepine use

psychiatric trauma

cognitive behavioral therapy

emergency department

Psychogenic Nonepileptic Seizure

Epileptic Seizure

Electroencephalography

Clinical Presentation

Atypical Seizure Pattern