1992 Volume 44 Issue 2 Pages 146-153
Generally, pseudoseizures are defined as a group of non-epileptic seizures which do not include those caused by anoxia. A part of these pseudoseizures can be attributed to a conversion symptom of hysteria and may be hardly differentiated from the true epileptic seizures. In the prsent communication, a rare case of hysteria, which exhibited pseudoseizures during sleep, is reported.
The patient was a 32-year-old male, who was struck over the right temporal area of his head with a crowbar when he was 26 years old. Brain CT scan did not reveal any abnormalities then. Three months after the incident, the patient started to experience cramps in the fingers of his right hand. Gradually the patient developed tonic seizures of the extremities followed by frequent generalized tonic convulsions. Epilepsy being suspected, the patient was treated with anti-epileptics, which were not effective. Due to the continuing frequent seizures and the ineffectiveness of the treatment, the patient was admitted to our hospital. At the time of admission, he had about 15 seizures per day.
During the hospital stay, the antiepilep tic medication was gradually discontinued with no signs of change in the patient's states. During EEG recordings, the patient had seizures without any positive findings (paroxysmal abnormalities) in the EEG. During all night sleep EEG recording, the patient had a seizure in stage II sleep, but no epilieptiform patterns were seen in this recording either.
This case wa s considered to be hysteria with somatic manifestation of psychological conflict induced by head trauma. The tonic seizures are the somatic manifestation, and they are considered pseudosizures (non-epilieptic) since there were no positive findings in EEGs, no changes in consciousness during the seizures, and no post-ictal stupors. Another factor supporting the diagnosis of pseudoseizures was that the frequency of the seizures increased according to the patients situation (e. g., he would have seizures when his desires were thwarted).
The prominent characteristics of his personality were theatricality, egocentrism, and dependency, which fit the description of a hysterical personality. Malingering was also considerd, but it was ruled out because of the seizure documented during stage II sleep.
