Abstracts

Rationale: Frontal lobe epilepsy, the second common type of epilepsy, is characterized by recurrent seizures arising from the largest brain lobe. Not to mention the motor or tonic/postural changes, the clinical features including brief, frequent attacks, complex motor automatisms with kicking and thrashing, sexual automatisms, and vocalization, serve to distinguish these seizures from complex partial seizures originating elsewhere. The constellation of clinical characteristics is often bizarre, leading to the erroneous diagnosis of hysteria. We report a 65 year-old female who was misdiagnosed as schizophrenia for 20 years. Her intermittent behavior changes rarely reappeared after she was treated with proper antiepileptic drugs. Methods: This is a case report of a patient who presented to the Buddhist Tzu Chi General Hospital for evaluation of recurrent psychomotor retardation. Results: The woman has had paroxysmal behavior changes with reduction in spontaneous action and speech, delayed and short responses to stimuli, repetition of a previous response to a subsequent stimulus, abnormal prolongation of a current activity and incontinence for 20 years. She would return to normal behavior in two days. Therefore she was diagnosed as schizophrenia and treated with low dose of antipsychotics and anxielytics. She had an EEG study in January 2009 for frequently occuring of abnormal psychobehvior. For abnormal findings in the study, she was admitted for long-term video EEG monitoring, brainimage and brain functional assessments. Video EEG monitoring demonstrated continuous rhythmical 2.5-3/second spikes and waves over the left frontal region with occasional spread to the right anterior region. Neither prominent motor manifestation such as dystonic posturing, jerking, bending, or rocking, nor gestural automastism was accompanied simultaneously. She was able to obey simple orders but not to follow sequential commands. Motor programming deficit was demonstrated by poorly performing three-step hand sequence and alternating programs. Transient suppression of the spiky EEG activity was obtained by intravenous administration of 2 mg lorazepam. The spiking EEG activity of left frontal region last for over 36 hours. The duration of episodic pscyhomotor retardation that her husband reported was accordant to the time of showing abnormal EEG activity. Brain MRI yielded normal results. The behavioral changes were rarely noticed since she had adequate dose of oxcarbazepine and topiramate. Conclusions: We described a woman with frontal non-convulsive status epilepticus with disturbances of higher cortical functions and preserved consciousness. The neurologic deficits were compatible with frontal convexity syndrome. This case highlights the potential for midinterpretation as psychiartic disorder.