scholarly journals Misdiagnosis of Epileptic Seizures as Manifestations of Psychiatric Illnesses

2011 ◽  
Vol 38 (3) ◽  
pp. 487-493 ◽  
Author(s):  
Seyed M. Mirsattari ◽  
Teneille E. Gofton ◽  
Derek J. Chong
Keyword(s):  
Psychiatric Symptoms ◽  
Case Series ◽  
Epileptic Seizures ◽  
Panic Attacks ◽  
Mesial Temporal Sclerosis ◽  
Contrast Study ◽  
Psychiatric Illnesses ◽  
Post Traumatic ◽  
Convulsive Seizures ◽  
Video Eeg

Background:Epileptic seizures may be misdiagnosed if they manifest as psychiatric symptoms or seizures occur in patients with known psychiatric illness.Methods:We present clinical profiles of six patients with epilepsy (three male, mean age 39 ± 12 years) that presented with prominent psychiatric symptoms.Results:Two patients had pre-existing psychiatric illnesses. Three patients were initially diagnosed with panic attacks, two with psychosis, and one with schizophrenia. Five patients had temporal lobe epilepsy (TLE) while the sixth patient was subsequently found to have absence status epilepticus (SE). Cranial computed tomogram (CT) including contrast study was unremarkable in five patients and showed post-traumatic changes in one patient. Cranial magnetic resonance imaging (MRI) revealed dysembryoplastic neuroepithelial tumour (DNET) in one patient, cavernous hemangioma in one, and post-traumatic changes plus bilateral mesial temporal sclerosis in another patient but it was normal in two TLE patients. Routine electroencephalography (EEG) revealed absence SE in one patient but it was non-diagnostic in the TLE patients. Video-EEG telemetry in the epilepsy monitoring unit (EMU) was necessary to establish the diagnosis in four TLE patients. None of the patients responded to medications aimed at treating psychiatric symptoms alone. Two patients required surgery while the other four required treatment with anti-epileptic drugs. All the patients had favorable response to the treatment of their epilepsy.Conclusions:This case series illustrates that epileptic patients may experience non-convulsive seizures that might be mistaken as primary psychiatric illnesses. In this subset of patients, evaluation by an epileptologist, MRI of the brain, and/or video-EEG telemetry in an EMU was necessary to confirm the diagnosis of epilepsy if routine EEGs and cranial CT are normal.

Neurologist, 13 years’ experience, Australia

2020 ◽  
pp. 204-206
Author(s):  
Markus Reuber ◽  
Gregg H. Rawlings ◽  
Steven C. Schachter
Keyword(s):  
Emergency Department ◽  
Behavioral Therapy ◽  
Epileptic Seizures ◽  
Clinical Psychologist ◽  
Eeg Monitoring ◽  
Patient Reported ◽  
History Of ◽  
Convulsive Seizures ◽  
One Year ◽  
Video Eeg

This chapter discusses the experience of a Neurologist with a patient who presented with a history of three bilateral convulsive seizures over a period of several months. The Neurologist started him on an adjunct antiepileptic therapy and he became seizure free. However, the situation changed dramatically after a stable period of twelve months. He started having seizures again and his mother was able to recognize that these seizures were different from those he had had one year earlier. Prolonged video-EEG monitoring confirmed the diagnosis of Non-Epileptic Seizures (NES). The Neurologist then referred the patient to a Clinical Psychologist, who used Cognitive Behavioral Therapy and taught him some techniques to cope with the condition. Eventually, the patient and his family were able to manage the NES better with the help of the psychologist. The patient reported a significant improvement clinically with less frequent NES and they learned how to manage the situation without visiting the Emergency Department.

scholarly journals Psychiatric presentation of voltage-gated potassium channel antibody-associated encephalopathy

2006 ◽  
Vol 189 (2) ◽  
pp. 182-183 ◽  
Author(s):  
U. D. Parthasarathi ◽  
T. Harrower ◽  
M. Tempest ◽  
J. R. Hodges ◽  
C. Walsh ◽  
...  
Keyword(s):  
Potassium Channels ◽  
Potassium Channel ◽  
Memory Impairment ◽  
Psychiatric Symptoms ◽  
Epileptic Seizures ◽  
Complete Recovery ◽  
Panic Attacks ◽  
Voltage Gated ◽  
With Memory

SummaryVoltage-gated potassium channel antibody encephalopathy, a rare cause of limbic encephalopathy, typically presents with memory impairment and seizures. Psychiatric symptoms have not been emphasised in the literature. Here we describe a 58-year-old man who presented with panic attacks and psychogenic non-epileptic seizures and, later on, developed delusions and hallucinations and then confusion. He was found to have antibodies to voltage-gated potassium channels. Treatment with immuno-modulatory therapy resulted in almost complete recovery.

scholarly journals Psychiatric symptoms in Ground Zero ironworkers in the aftermath of 9/11: prevalence and predictors

2009 ◽  
Vol 33 (2) ◽  
pp. 49-52 ◽  
Author(s):  
Craig L. Katz ◽  
Stephen Levin ◽  
Robin Herbert ◽  
Simon Munro ◽  
Anand Pandya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alcohol Misuse ◽  
Psychiatric Symptoms ◽  
Panic Attacks ◽  
Traumatic Experience ◽  
Post Traumatic Stress ◽  
Ground Zero ◽  
Post Traumatic ◽  
Operation Risk ◽  
Anxiety Depression

Aims and MethodTo establish the prevalence of, and risk factors for, psychiatric symptoms in Ground Zero ironworkers. Questionnaires commonly used to screen for psychiatric symptoms were completed by 124 workers.ResultsWe have established the prevalence of screening positive for symptoms of post-traumatic stress disorder, panic attacks, generalised anxiety, depression and alcohol misuse. Among the risk factors were alcohol misuse, injury to or death of a family member, friend or co-worker at Ground Zero and one or more adverse life events since 9/11.Clinical ImplicationsIronworkers at Ground Zero tend to have significant psychiatric symptoms likely to be associated with the traumatic experience of working there during the clean-up operation. Risk factors for psychiatric symptoms were established.

scholarly journals Post-traumatic inclusion cysts of the iris: a longterm prospective case series

2007 ◽  
Vol 85 (8) ◽  
pp. 893-896 ◽  
Author(s):  
Viney Gupta ◽  
Aparna Rao ◽  
Ankur Sinha ◽  
Neena Kumar ◽  
Ramanjit Sihota
Keyword(s):  
Case Series ◽  
Post Traumatic ◽  
Prospective Case Series

Sertraline as a treatment for PTSD: a systematic review and meta-analysis

2004 ◽  
Vol 21 (3) ◽  
pp. 100-103 ◽  
Author(s):  
Paul Mooney ◽  
Janette Oakley ◽  
Michael Ferriter ◽  
Raymond Travers
Keyword(s):  
Systematic Review ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Meta Analysis ◽  
Case Series ◽  
Group Differences ◽  
Post Traumatic Stress ◽  
Relevant Research ◽  
Randomised Control Trials ◽  
Post Traumatic

AbstractObjective: Post-traumatic stress disorder (PTSD) is one of the most prevalent psychological disorders. Methods to alleviate its symptoms range from ‘talking therapies’ to pharmaceutical interventions. Our objective was to carry out a systematic review of the effectiveness of sertraline, an SSRI, as a treatment for PTSD.Method: Databases were searched to identify relevant research on sertraline as a treatment for PTSD.Results: Five randomised control trials were identified, along with seven open trials and case series studies.Conclusions: The review and meta-analysis supported the use of sertraline for PTSD though further research on sub-group differences (eg. gender) is required.

scholarly journals Post-traumatic superolateral dislocation of condyle: A case series of 18 condyles with review of literature and a proposed classification.

2017 ◽  
Vol 7 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Dichen Palmo Bhutia ◽  
Divya Mehrotra ◽  
Nitin Mahajan ◽  
Debraj Howlader ◽  
Jagdish Gamit
Keyword(s):  
Case Series ◽  
Review Of Literature ◽  
Post Traumatic

scholarly journals Movement-induced heart rate changes in epileptic and non-epileptic seizures

2009 ◽  
Vol 67 (3b) ◽  
pp. 789-791 ◽  
Author(s):  
Gisele R. de Oliveira ◽  
Francisco de A.A. Gondim ◽  
Edward R. Hogan ◽  
Francisco H. Rola
Keyword(s):  
Heart Rate ◽  
Motor Activity ◽  
Rate Increase ◽  
Epileptic Seizures ◽  
Baseline Heart Rate ◽  
Heart Rate Increase ◽  
Event Duration ◽  
Rate Analysis ◽  
Heart Rate Analysis ◽  
Video Eeg

Heart rate changes are common in epileptic and non-epileptic seizures. Previous studies have not adequately assessed the contribution of motor activity on these changes nor have evaluated them during prolonged monitoring. We retrospectively evaluated 143 seizures and auras from 76 patients admitted for video EEG monitoring. The events were classified according to the degree of ictal motor activity (severe, moderate and mild/absent) in: severe epileptic (SE, N=17), severe non-epileptic (SNE, N=6), moderate epileptic (ME, N=28), moderate non-epileptic (MNE, N=11), mild epileptic (mE, N=35), mild non-epileptic (mNE, N=33) and mild aura (aura, N=13). Heart rate increased in the ictal period in severe epileptic, severe non-epileptic, moderate epileptic and mild epileptic events (p<0.05). Heart rate returned to baseline levels during the post ictal phase in severe non-epileptic seizures but not in severe epileptic patients. Aura events had a higher baseline heart rate. A cut-off of 20% heart rate increase may distinguish moderate epileptic and mild epileptic events lasting more than 30 seconds. In epileptic seizures with mild/absent motor activity, the magnitude of heart rate increase is proportional to the event duration. Heart rate analysis in seizures with different degrees of movement during the ictal phase can help to distinguish epileptic from non-epileptic events.

scholarly journals Ictal ECG changes in temporal lobe epilepsy

1995 ◽  
Vol 53 (3b) ◽  
pp. 619-624 ◽  
Author(s):  
L.M. Li ◽  
J. Roche ◽  
J.W.A.S. Sander
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Sinus Bradycardia ◽  
Cardiac Pacemaker ◽  
Epileptic Seizures ◽  
Ecg Changes ◽  
Unexpected Death ◽  
Complex Partial Seizures ◽  
The Mean ◽  
Video Eeg

Changes in cardiac rhythm may occur during epileptic seizures and this has been suggested as a possible mechanism for sudden unexpected death amongst patients with chronic epilepsy (SUDEP). We have studied ECG changes during 61 complex partial seizures of temporal lobe origin in 20 patients. Tachycardia was observed in 24/61 (39%) and bradycardia in 3/61 (5%). The mean and median tachycardia rate was 139 and 140 beats/min (range 120-180). The longest R-R interval observed was 9 seconds. No difference was found in regard to the lateralisation of seizures and cardiac arrhytmia. One of the patients with bradycardia was fitted with a demand cardiac pacemaker, which appeared to decrease the number of his falls. In conclusion, ictal cardiac changes which may be seen in temporal lobe epilepsy (TLE) are sinus tachycardia and occasionally sinus bradycardia. Patients presenting vague complains suggestive of either TLE or cardiac dysrhythmia, simultaneous monitoring with EEG/ECG is required, and if the episodes are frequent, video-EEG should be considered. Further studies on this subject are warranted as this may shed some light on possible mechanisms for SUDEP.

scholarly journals A broad spectrum of posterior reversible encephalopathy syndrome - a case series with clinical and paraclinical characterisation, and histopathological findings

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fatme Seval Ismail ◽  
Johannes van de Nes ◽  
Ilka Kleffner
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical Symptoms ◽  
Brain Mri ◽  
Case Series ◽  
Epileptic Seizures ◽  
Retrospective Case ◽  
Posterior Reversible Encephalopathy ◽  
Histopathological Findings ◽  
Delay In Diagnosis ◽  
Reversible Encephalopathy

Abstract Background Posterior reversible encephalopathy syndrome (PRES) is clinical-neuroradiologically defined and potentially reversible, so there are limited data about histopathological findings. We aimed to describe the clinical and paraclinical features of patients with PRES with regard to its reversibility. Methods This retrospective case series encompasses 15 PRES cases out of 1300 evaluated patients from a single German center between January 1, 2010, and June 15, 2020. PRES was established according to the diagnostic criteria as proposed by the Berlin PRES Study 2012. One of the cases studied was subject to brain autopsy. Results From the 15 patients studied (median age 53 years, range 17–73; 11 female), 67 % presented with epileptic seizures, 40 % suffered from encephalopathy with reduced consciousness and 53 % developed delirium, while 47 % had headache and visual disturbances. Subcortical brain MRI abnormalities related to PRES were observed in all patients. One patient developed spinal ischemia and another Guillain-Barré syndrome in addition to PRES. Hypertensive blood pressure was the main underlying/trigger condition in all patients. Clinical symptoms and MRI changes were not reversible in 42 %, even progressive in 3 out of these 5 patients. Median time from symptom onset to diagnosis in these non-reversible cases was 7 days (range 0–13), while the median delay in diagnosis in the reversible group was 1 day (range 0–3). Cerebellar/brain stem involvement and status epilepticus were more frequently in patients with non-reversible disease course. Mortality due to PRES occurred in 13 % of these patients. Neuropathological examination of the brain of a 57-year-old female patient revealed major leukencephalopathic changes, fibrinoid necrosis of endothelial cells and fresh petechial hemorrhages in accordance with PRES. Conclusions Our case series demonstrates that PRES was not reversible in 42 % of the studied patients. Delay in diagnosis seems to contribute to limited reversibility and poor outcome.

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