Bao Shimin, Egbuta Caleb Onyenaturuchi, Li Jinmei
Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China.
Department of Neurology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.), Chengdu, 610041, China.
Acta Epileptol. 2025 Mar 4;7(1):15. doi: 10.1186/s42494-025-00210-w.
Dissociative seizures (DS), also known as psychogenic non-epileptic seizures (PNES), often mimic epileptic seizures (ES), leading to misdiagnosis, unnecessary anti-seizure medications (ASMs)/ suboptimal use of ASMs, and delays in appropriate care in approximately one-third of patients. Rare presentations, such as episodes resembling oculogyric crisis (OGC), further complicate differentiation. This report highlights the diagnostic challenges of DS with atypical features and emphasises the role of video-electroencephalogram (VEEG) in early differentiation.
We present a 16-year-old male with recurrent episodes of upward eye deviation, non-synchronised limb twitching, and bizarre behaviours, initially misdiagnosed as epilepsy and autoimmune encephalitis. Comprehensive investigations, including normal neuroimaging, absence of epileptiform activity on VEEG, and psychological evaluation revealing moderate depression, supported a diagnosis of DS. The patient showed significant improvement with sertraline and cognitive behavioural therapy.
This case underscores the diagnostic challenges posed by atypical DS presentations and highlights the value of/need for VEEG and psychiatric evaluation in differentiation. Early identification of DS can prevent mismanagement and optimize outcomes.
分离性癫痫发作（DS），也称为精神性非癫痫性发作（PNES），常模仿癫痫发作（ES），导致误诊、不必要的抗癫痫药物（ASM）使用/ASM使用不当，以及约三分之一患者的适当治疗延迟。罕见表现，如类似动眼危象（OGC）的发作，进一步使鉴别复杂化。本报告强调了具有非典型特征的DS的诊断挑战，并强调了视频脑电图（VEEG）在早期鉴别中的作用。
我们报告一名16岁男性，有反复发作的向上眼球偏斜、肢体不同步抽搐和怪异行为，最初被误诊为癫痫和自身免疫性脑炎。综合检查，包括正常的神经影像学检查、VEEG上无癫痫样活动，以及心理评估显示中度抑郁，支持DS的诊断。患者使用舍曲林和认知行为疗法后有显著改善。
该病例强调了非典型DS表现带来的诊断挑战，并突出了VEEG和精神科评估在鉴别中的价值/必要性。早期识别DS可防止管理不当并优化治疗结果。
