Abstract

Psychogenic non-epileptic events (PNEEs) can mimic epileptic seizures and may present as prolonged convulsive episodes mimicking convulsive (CSE) and non-convulsive status epilepticus (NCSE), leading to unnecessary- and potentially harmful- treatment. We report the case of a 20-year-old male with no significant past medical history who presented to the emergency department with a 5-hour history of continuous jerky movements of all limbs. In the ED he was diagnosed with CSE and administered 2 mg of midazolam and then loaded with levetiracetam. Neurological examination and routine investigations were unremarkable. Bedside continuous video EEG monitoring showed no epileptiform discharges or surface EEG correlate to the ongoing “ictal” event, supporting a diagnosis of psychogenic CSE. Following multidisciplinary and psychological evaluation, the patient was diagnosed with psychogenic CSE and managed with antidepressants, anxiolytics and cognitive behavioral therapy.

Keywords

:psychogenic non-epileptic events, cognitive behavioural therapy, electroencephalogram, convulsive status epilepticus