Jung EPark, Neurologist, National Institutes of Healthjunge.park@nih.gov
Submitted May 06, 2015
Dr. Feld shared a vivid story of her past experience as an intern taking care of a patient who was later determined to have non-epileptic seizures. [1] Many readers may have had similar cases of patients receiving work-up and treatment based on the assumption that the problem was due to an organic neurological disorder. The author described the patient's seizures as "well-rehearsed limb- flailing performances designed to elicit Ativan injections from inexperienced house staff", and also provides details on the patient's seemingly timed seizure-like events when less-experienced junior residents were present. While the seizures described seem classic for non-epileptic seizures, are we confident assuming that this was a case of malingering ("well-rehearsed ...performances designed to elicit...")?
Patients with psychogenic non-epileptic seizures receive unnecessary evaluation and admissions, sometimes resulting in medical complications. [2] Psychogenic non-epileptic seizures should be considered in the differential for this patient, as there is no evidence in this story to support that there was intentional production of symptoms. Psychogenic neurological disorders are involuntary and very "real", causing considerable disability. [3] Recognition of this may be important, as I am sure we will all meet our own "Steven Ferris" one day.
1. Feld ED. Reflections: Neurology and the Humanities: Better you than me. Neurology 2015;84;1607-1608.
2. LaFrance WC, Jr., Barry JJ. Update on treatments of psychological nonepileptic seizures. Epilepsy Behav 2005;7:364-374.
3. Thomas M, Vuong KD, Jankovic J. Long-term prognosis of patients with psychogenic movement disorders. Parkinsonism Relat Disord 2006;12:382-387.
For disclosures, contact the editorial office at journal@neurology.org.
Dr. Feld shared a vivid story of her past experience as an intern taking care of a patient who was later determined to have non-epileptic seizures. [1] Many readers may have had similar cases of patients receiving work-up and treatment based on the assumption that the problem was due to an organic neurological disorder. The author described the patient's seizures as "well-rehearsed limb- flailing performances designed to elicit Ativan injections from inexperienced house staff", and also provides details on the patient's seemingly timed seizure-like events when less-experienced junior residents were present. While the seizures described seem classic for non-epileptic seizures, are we confident assuming that this was a case of malingering ("well-rehearsed ...performances designed to elicit...")?
Patients with psychogenic non-epileptic seizures receive unnecessary evaluation and admissions, sometimes resulting in medical complications. [2] Psychogenic non-epileptic seizures should be considered in the differential for this patient, as there is no evidence in this story to support that there was intentional production of symptoms. Psychogenic neurological disorders are involuntary and very "real", causing considerable disability. [3] Recognition of this may be important, as I am sure we will all meet our own "Steven Ferris" one day.
1. Feld ED. Reflections: Neurology and the Humanities: Better you than me. Neurology 2015;84;1607-1608.
2. LaFrance WC, Jr., Barry JJ. Update on treatments of psychological nonepileptic seizures. Epilepsy Behav 2005;7:364-374.
3. Thomas M, Vuong KD, Jankovic J. Long-term prognosis of patients with psychogenic movement disorders. Parkinsonism Relat Disord 2006;12:382-387.
For disclosures, contact the editorial office at journal@neurology.org.