Breach effect over mitten patterns mimicking focal spike-waves in a patient with psychogenic nonepileptic seizures

摘要

Psychogenic nonepileptic seizures (PNES) resemble epileptic seizures. Video-EEG is the gold-standard diagnostic tool (Reuber, 2009). About 20% of patients with PNES are misdiagnosed as epileptics (Boesebeck et al, 2010), mainly by EEG overinterpretation (Benbadis and Tatum, 2003). We saw a 48-years-old woman with spells since she was 14, taking three antiepileptic drugs (AEDs), and having three seizures by day on admission. An aneurysm was clipped 2 years before through a left frontotemporal craniotomy. We recorded a video-EEG, with the following technical parameters: time constant, 0.1 s; high-frequency filter, 70 Hz; sensitivity, 10muV/mm; page size, 10 s. PNES were characterized by a motionless stare during 3 min. On sleep, breach effect over mitten patterns mimicked frontal spike-and-wave complexes (Fig. 1).