PDF(Pubmed)
Abstract：
Psychogenic non-epileptic seizures (PNES) involve episodes of movement, sensation, or behaviors that may appear clinically similar to epileptic seizures but without cortical electroencephalographic activity that defines epileptic seizures. This case report involves a 29-year-old male with a history of type I diabetes mellitus, schizophrenia, and a prior suicide attempt via insulin overdose. He was admitted to the emergency department after being found unresponsive on the floor in his bedroom. Given the nature of his prior suicide attempt, he was initially treated for hypoglycemic coma. After arrival at the emergency department, he was noted to have normal blood glucose but displayed symptoms of acute psychosis and was transferred to the behavioral health unit, where subsequent paroxysmal episodes with seizure-like features were observed. He then underwent video-electroencephalography monitoring to evaluate for epilepsy. After no epileptic activity was recorded, he was transferred back to the behavioral health unit and treated for underlying schizophrenia and suspected PNES. After showing gradual improvement on antipsychotic medication, no further seizure-like activity was observed. His stay was complicated by a SARS-CoV-2 infection, which he recovered from without complication, and he was released on day 11. Extensive education was provided for the patient and his family on recognizing the symptoms of PNES and the importance of adherence to antipsychotic medication to avoid psychiatric decompensation and PNES recurrence. This case report highlights the challenge of diagnosing and treating a patient with PNES with underlying psychiatric comorbidities and a history of insulin overdose.
摘要：
心因性非癫痫发作（PNES）涉及运动发作，感觉，或临床上可能与癫痫发作相似的行为，但没有定义癫痫发作的皮质脑电图活动。该病例报告涉及一名29岁男性，有I型糖尿病病史，精神分裂症,以及之前通过胰岛素过量自杀的企图.在卧室的地板上被发现反应迟钝后，他被送往急诊室。鉴于他先前自杀未遂的性质,他最初接受低血糖昏迷治疗。到达急诊室后，他被发现血糖正常，但表现出急性精神病症状，并被转移到行为健康部门，随后观察到具有癫痫样特征的阵发性发作。然后，他接受了视频脑电图监测，以评估癫痫。在没有记录到癫痫活动后,他被转回行为健康单元,并接受潜在精神分裂症和疑似PNES的治疗.在抗精神病药物逐渐改善后，未观察到进一步的癫痫样活动.他的逗留因SARS-CoV-2感染而变得复杂，他没有并发症就康复了，他在第11天被释放了.为患者及其家人提供了广泛的教育，以了解PNES的症状以及坚持使用抗精神病药物以避免精神病代偿失调和PNES复发的重要性。此病例报告强调了诊断和治疗具有潜在精神病合并症和胰岛素过量史的PNES患者的挑战。
