Abstracts

Rationale: The differential diagnosis between refractory seizures and non-epileptic seizures is often difficult and requires dedicated investigation, comprising extensive VEEG monitoring. Although most cases are somewhat refractory to medical treatment alone, requiring psychotherapy and a dedicated psychiatric follow-up, they are usually considered benign when compared to epileptic seizures, as they do not lead to physical trauma. We report two cases of potentially life-threatening non-epileptic seizures. Methods: The authors report two different cases of patients diagnosed with non-epileptic seizures who attempted suicide following the disclosure of their diagnosis. Results: Case 1: A 48 year-old female patient with a history of refractory epilepsy was admitted to our VEEG monitoring unit for diagnostic clarification of spells. A previous brain MRI disclosed a left perimesencephalic cistern lesion and she underwent surgical removal in another hospital; pathological diagnosis was of an epidermoid cyst. Following surgery there was an increase in seizure frequency, which led to admission to a VEEG monitoring unit at that first hospital and a diagnosis of non-epileptic seizures. Prior to her admission to our unit a new MRI disclosed a lesion similar to the one that had been supposedly removed. She remained refractory to medical treatment and was referred to our service. During a 48-hour VEEG five events were recorded, all of which had the semiological features compatible with non-epileptic seizures. No epileptic seizures were recorded. The patient received the diagnosis of non-epileptic seizures in a comprehensive setting and was sent for psychiatric treatment, as well as following-up with our service in an out-patient setting. She attempted suicide by introducing sewing needles in her anterior thoracic wall, which resulted in cardiac tamponade that was surgically treated with a pericardiac window and drainage. This suicide attempt occurred following a widespread media-coverage of an infant who had been a victim of attempted murder by his step-father, who drugged him and then inserted 31 sewing needles under the baby s skin. Following that, she reported having previously attempted suicide on another occasion. Case 2: A 30 year-old female patient with a history of refractory epilepsy was admitted to the VEEG monitoring unit, during which she recorded twelve non-epileptic seizures. Her EEG activity was otherwise normal, with no epileptic paroxysms. During her stay she attempted suicide twice, the first time by ingesting 12 pills of Phenobarbital, which as treated with gastric drainage and supportive care. The second time she attempted to jump out of a window of the fourth floor, but was contained and transferred to a psychiatric hospital. Conclusions: Even though some physicians would dismiss non-epileptic seizures, considering them to be less threatening than epileptic-seizures, sometimes the psychopathology leading to the development of non-epileptic seizures can be so disturbing as to make these events potentially life-threatening.