2025 Volume 53 Issue 3 Pages 136-140
We report a case of psychogenic non-epileptic seizures (PNES) after intravenous sedation and tooth extraction. The patient was a 29-year-old woman who was scheduled to undergo intravenous sedation because of her fear of the treatment. The patient was currently being treated for chronic pain, somatoform disorder, and dissociative disorder and had been prescribed diazepam (DZP) for PNES. A dental procedure was performed under intravenous sedation with propofol (PPF). Immediately after the procedure, the patient had a seizure with convulsions and became unresponsive ; as her condition did not improve and the seizure was difficult to manage, the patient was transported to an emergency hospital. After a detailed examination at the emergency hospital, the incident was identified as a PNES seizure. Wisdom tooth extraction was scheduled for a later date, and the procedure was performed under local anesthesia. Limb convulsions occurred during the local anesthesia, which were alleviated by the administration of DZP ; the tooth was successfully extracted. After the tooth extraction, the patient had a PNES seizure similar to the seizure that occurred during the first treatment, but she improved after the administration of midazolam (MDZ). The patient was discharged home on the same day. The trigger of this patient’s PNES episodes was thought to be stress brought on by her fear of dental treatment, the securement of an intravenous line before the start of sedation, and vascular pain caused by PPF. Detailed patient information and perioperative stress should be considered when planning treatment. The administration of MDZ was effective at the onset of PNES.
