Definitely, Maybe: It’s not always Epilepsy

Abstract

Background: Psychogenic Non-Epileptic Seizures (PNES) are underrecognized due to variety of symptoms (including behavioral abnormalities) and duration (usually more than 5 minutes).

Case History: A 37 y/o woman has been treated with carbamazepine for 20 years for post-meningioma excision epilepsy. He presented with asthenia and, during observation, he also experienced loss of consciousness accompanied by generalized hypertonia, tremor and hyperpnea. Vital signs remained normal. Due to a suspicion of seizure, diazepam was administered followed by propofol and midazolam which resolved hypertonia and led to slow recovery. Cranial CT scan and serial arterial blood gas revealed: malacic hypodensity in the left parietal lobe (site of the previous surgery) and elevated lactate levels (Table 1). The next day, a neurologist ordered an EEG, which showed normal results. The patient was discharged with diagnosis of PNES.