De Novo Psychogenic Nonepileptic Seizures After Epilepsy Surgery: A Case Report
Journal Title: Journal of Neurological Sciences-Turkish - Year 2007, Vol 24, Issue 2
Abstract
Psychogenic nonepileptic seizures (PNES) are operationally defined as episodes of behavioral events similar to epilepsy, but caused by a psychological process and not associated with abnormal electrical discharges in the brain. About 20% of patients referred for epilepsy surgery centers presumed refractory epileptic seizures prove to have purely PNES. The differentiation of PNES from epileptic seizures is difficult. The management of PNES as epileptic seizures can lead to unnecesseray and inappropriate medical antiepileptic treatment. Moreover, the failure to recognize PNES and the psychological cause of the disorder can lead to suicide of the patient. Accordingly diagnosis of PNES or epileptic seizure can decrease the rate of mortality and morbidity. Several groups have observed the development of PNES after epilepsy surgery in patients with different localization and pathology of epileptic focuse. Reported incidence rates of such seizures vary between 1.8 and 8.8 %. We report here one patient who had PNES after surgery, in homogeneous group of 130 patients with mesial temporal lobe epilepsy and hippocampal sclerosis. Examining of semiological and elctrophysiolgical features of her attacks by video-EEG monitoring, prevent the incorrect diagnosis and treatment. Psychiatric evaluation of patients with refractory epileptic seizures before epilepsy surgery may be suggestive for effect of mood instability and occurance of PNES after surgery. Preventive strategies against these problems with colloboration can lead to better results. That case report suggest that psychiatrist, psychologist must be involved in addition to neurologist, neurosurgeon, neroradiologist, specialist in nuclear medicine for evaluation of epileptic patients before and after epilepsy surgery.
Authors and Affiliations
Irsel TEZEL, Aylin ULUSAHIN, Serap SAYGI
Keywords
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