The “dual diagnosis” of pharmacoresistant epilepsy and psychogenic non-epileptic seizures. Clinical case

Abstract

Introduction According to the ICD-10, psychogenic non-epileptic seizures (PNES) are classified as dissociative disorders [1]. Patients with drug-resistant epilepsy are at higher risk of developing PNES, which are diagnosed in 20-30% of patients with drug-resistant epilepsy [2]. Aim To make differential diagnosis between epileptic seizures and PNES, and to demonstrate the combination of those in “dual diagnosis”. Material and methods Case of a 42-year-old patient, with epilepsy from the age of 13, suspected of being drug-resistant on polytherapy with Carbamazepine 1200 mg/day, Levetiracetam 3000 mg/day and Topiramate 50 mg/day. Conclusions In the management of epilepsy, suspected of being drug-resistant, it is necessary to consider the possibility of the presence of epileptic seizures and PNES, the importance of multidisciplinary team collaboration and electrographic correlations on EEG.