Identifying Myoclonic Epilepsy Misdiagnosed as Psychogenic Nonepileptic Seizures: Challenges in Differential Diagnosis

TL;DR

A young woman initially diagnosed with psychogenic nonepileptic seizures was later found to have myoclonic epilepsy after further testing.

Contribution

Highlights the diagnostic challenges in differentiating myoclonic epilepsy from psychogenic nonepileptic seizures.

Findings

Initial EEG did not show epileptiform activity, leading to a PNES diagnosis.

Repeat EEG revealed generalized spike-and-wave discharges, confirming myoclonic epilepsy.

Treatment with valproate significantly reduced seizure frequency.

Abstract

Psychogenic nonepileptic seizures (PNES) and epileptic seizures often present with similar clinical manifestations. This case report describes the diagnostic journey of a 24-year-old female initially diagnosed with PNES but later found to have myoclonic epilepsy upon comprehensive evaluation. The patient presented with recurrent episodes characterized by sudden loss of awareness, jerking movements, and urinary incontinence, often triggered by stressors. Initial assessment, including video-electroencephalography (EEG) monitoring, did not reveal epileptiform activity, leading to the provisional diagnosis of PNES. However, the persistence of symptoms and doubts regarding the diagnosis prompted further investigation, which uncovered generalized spike-and-wave discharges on repeat EEG studies. The diagnosis of myoclonic epilepsy was established based on these findings, and treatment with valproate resulted in a significant reduction in seizure frequency. This case underscores the importance of a thorough evaluation in distinguishing between seizure disorders and psychogenic manifestations, emphasizing the need for collaborations between neurology and psychology disciplines for accurate diagnosis and management.

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