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Epilepsy

Auto Accident and Myoclonic Episodes

08/24/2009

Question:

Within a month after an auto/semi accident my son started having involuntary twitches and spasms. Last year he had an episode where his speech was very slurred and he had trouble putting together thought/sentences (almost sounded like someone who had a stroke). Pain management Doctor (back pain from accident) put on Klonopin & Neurontin & referred to neurologist. EEG with video monitoring came back normal, but had only been off Klonopin for 24 hours. They diagnosed as PNES - but I think this came from undetected brain injury(neuropsychological testing showed some unexplainable differences/problem). He has tried to control/stop mentally and can`t; psychologist thinks from brain injury not psychiatric problem. Please, do you have any advice? Current neurologist is a specialist in sleep disorders and doesn`t seem to know anything about mild TBI. Episodes start with twitching/jerk and progress to whole body shaking, sometimes he will drop something with no warning, sometimes facial contorsions. Can you give me some guidance? Thank you.

Answer:

Psychogenic seizures are often called non-epileptic seizures though the symptoms may lead patients and health care providers to believe they are a sign of epilepsy. However, epileptic seizures are caused by sudden abnormal electrical discharges in the brain. Psychogenic non-epileptic seizures are attacks that may look like epileptic seizures, but are not caused by abnormal brain electrical discharges. They are stress or emotionally related. Psychogenic seizures are most often misdiagnosed as epilepsy. These seizures are not rare - in fact, one in five patients sent to an epilepsy specialist for difficult seizures is found to have psychogenic seizures. The treatment of psychogenic seizures is not with seizure medication but require psychiatric or psychology consultation to find the underlying stress that is the cause.

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Response by:

David M Ficker, MD David M Ficker, MD
Associate Professor
College of Medicine
University of Cincinnati