Functional Neurological Disorder Presenting as Apparent Drug-Resistant Seizures: A Case Report on Emphasizing the Role of Early Diagnosis

TL;DR

A young woman misdiagnosed with epilepsy for years was found to have functional neurological disorder, which resolved with proper diagnosis and treatment.

Contribution

This case emphasizes the importance of early FND diagnosis to avoid unnecessary epilepsy treatments.

Findings

The patient's seizures had no electrographic correlate, confirming FND.

Discontinuation of antiseizure medications and initiation of therapy led to full resolution of symptoms.

Early FND diagnosis can improve quality of life and avoid unnecessary treatments.

Abstract

Functional neurological disorder (FND) is a complex and frequently misdiagnosed condition characterized by neurological symptoms such as motor events, sensory deficits, or altered consciousness caused by brain network dysfunction rather than structural abnormalities. Despite its prevalence, FND remains stigmatized and underrecognized, mainly due to its historical association with psychological factors and its disproportionate impact on women. We present the case of a 19-year-old biological woman with a seven-year history of presumed epilepsy, treated with multiple antiseizure medications despite inconclusive findings on brain magnetic resonance imaging (MRI) and EEG. Her medical history included post-traumatic stress disorder and a family history of epilepsy involving both first and second degree relatives, including one case associated with tuberous sclerosis. At 18 years of age, she was hospitalized after several functional seizures requiring orotracheal intubation, though EEG and brain MRI remained normal. She continued to experience functional seizures. A video-EEG eventually recorded multiple events without an electrographic correlate, confirming the FND diagnosis. Following diagnosis, antiseizure medications (ASM) were gradually withdrawn, and she initiated cognitive-behavioral therapy and sertraline. The patient achieved complete resolution of functional events and reported significant improvement. This case highlights the importance of early consideration of FND in patients with drug-resistant seizures and non-correlating diagnostics to avoid unnecessary treatments and improve quality of life.

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