Therapeutic Effect of Epilepsy Diagnosis Using Video-Electroencephalography in an Adult Misdiagnosed With Apathy and Psychogenic Nonepileptic Seizures: A Case Report.

Patients with epilepsy frequently present with comorbid psychiatric symptoms such as depression, anxiety, and apathy. In cases of drug-resistant epilepsy with prominent psychiatric symptoms, misdiagnosis as psychogenic nonepileptic seizures (PNES) is common. Video-electroencephalogram (VEEG) can play a critical role in differentiating PNES from epileptic seizures. VEEG has also been reported to have therapeutic benefits in PNES. However, its effects on psychiatric symptoms related to epilepsy, excluding PNES, have not been reported. Herein, we report a case of apathy that occurred after the onset of epilepsy and improved following a definitive diagnosis using VEEG. A 25-year-old woman exhibiting traits consistent with autism spectrum disorder was referred for the differential diagnosis of PNES. Social activity decreased after the onset of seizures, and marked apathy was observed after the mother began over-involvement. The seizures initially presented as focal clonic seizures and evolved into focal to bilateral tonic-clonic seizures, but over time, seizures with impaired consciousness began to appear. Combined with the presence of severe apathy, all seizures were misdiagnosed as PNES. After epilepsy was confirmed by VEEG, the patient's apathy improved markedly, and the frequency of seizures decreased. When apathy worsened again due to seizure recurrence after discharge, VEEG was ineffective. Following the initiation of occupational therapy (OT), apathy gradually improved, and no further exacerbation of apathy was observed, even in the presence of seizures. This case underscores the therapeutic potential of VEEG. The patient was initially misdiagnosed with PNES due to the combination of severe apathy and seizures suspected to be PNES. However, the correct diagnosis and educational effect provided by VEEG contributed to an improvement in apathy. Following the diagnosis via VEEG, the frequency of seizures also decreased without any changes to antiepileptic medications, suggesting that the improvement in psychiatric symptoms positively impacted the control of epileptic seizures. Although VEEG was ineffective during the recurrence of apathy triggered by seizures, gradual improvement was observed through OT and encouragement of independence. Furthermore, continued OT in outpatient settings prevented further worsening of apathy related to seizures. In this case, apathy improved following a definitive diagnosis of epilepsy using VEEG. VEEG not only facilitated accurate epilepsy diagnosis but also improved apathy and seizure control, underscoring both its diagnostic and therapeutic value. Further research is warranted to explore standardized assessments of psychiatric symptoms before and after VEEG to optimize care in complex epilepsy cases.