Abstracts

Rationale: Mistaking Psychogenic Non-Epileptic Spells (PNES) for Epileptic Seizures (ES) can be dangerous (1), and certain features should alert physicians to possible PNES (2).Methods: A 28 year-old man was transferred from another hospital for management of uncontrolled convulsions despite four antiepileptic drugs (AEDs) with therapeutic serum levels. He had a central venous catheter (CVC), presumably for protein C infusions. His brain MRI was normal. Results: He had no episodes for two days during video-EEG monitoring. He then disconnected his EEG cables and had an episode that was captured on video and consisted of generalized stiffening with evident cyanosis, followed by jerking and profuse bleeding from the mouth. The manifestations were unusually similar to those of ES, except that, at some points he postured his hands and feet in awkward positions, and was clearly startled by spraying water on his face. It turned out that he had sucked blood from his own CVC to slaver it during the episode while consciously holding his breath. Conclusions: Consciously-produced factitious PNES may be more difficult to differentiate from ES than somatoform PNES. The normal EEG and self-disconnection from EEG raised the possibility of factitious disorder. Significance: Physicians must consider the possibility of PNES before implementing major interventions. REFERENCES: 1. Reuber M, Baker GA, Gill R, Smith DF, Chadwick DW. Failure to recognize psychogenic nonepileptic seizures may cause death. Neurology 2004;62:834-835. 2. Syed TU, LaFrance WC, Jr., Kahriman ES, Hasan SN, Rajasekaran V, Gulati D, Borad S, Shahid A, Fernandez-Baca G, Garcia N, Pawlowski M, Loddenkemper T, Amina S, Koubeissi MZ. Can semiology predict psychogenic nonepileptic seizures? A prospective study. Ann Neurol 2011;69:997-1004.