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Misdiagnosis of Epileptic Seizures as Manifestations of Psychiatric Illnesses

Published online by Cambridge University Press:  02 December 2014

Seyed M. Mirsattari ,
Teneille E. Gofton  and
Derek J. Chong
Seyed M. Mirsattari*
Affiliation:
Department of Clinical Neurological Sciences, The University of Western Ontario, London, Ontario, Canada Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada Department of Medical Imaging, The University of Western Ontario, London, Ontario, Canada Department of Psychology, The University of Western Ontario, London, Ontario, Canada
Teneille E. Gofton
Affiliation:
Department of Clinical Neurological Sciences, The University of Western Ontario, London, Ontario, Canada
Derek J. Chong
Affiliation:
Comprehensive Epilepsy Centre, Columbia University Medical Center, New York, NY, USA
*
B10-108, London Health Sciences Centre, 339 Windermere Road, London, Ontario, N6A 5A5, Canada
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Abstract

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Background:

Epileptic seizures may be misdiagnosed if they manifest as psychiatric symptoms or seizures occur in patients with known psychiatric illness.

Methods:

We present clinical profiles of six patients with epilepsy (three male, mean age 39 ± 12 years) that presented with prominent psychiatric symptoms.

Results:

Two patients had pre-existing psychiatric illnesses. Three patients were initially diagnosed with panic attacks, two with psychosis, and one with schizophrenia. Five patients had temporal lobe epilepsy (TLE) while the sixth patient was subsequently found to have absence status epilepticus (SE). Cranial computed tomogram (CT) including contrast study was unremarkable in five patients and showed post-traumatic changes in one patient. Cranial magnetic resonance imaging (MRI) revealed dysembryoplastic neuroepithelial tumour (DNET) in one patient, cavernous hemangioma in one, and post-traumatic changes plus bilateral mesial temporal sclerosis in another patient but it was normal in two TLE patients. Routine electroencephalography (EEG) revealed absence SE in one patient but it was non-diagnostic in the TLE patients. Video-EEG telemetry in the epilepsy monitoring unit (EMU) was necessary to establish the diagnosis in four TLE patients. None of the patients responded to medications aimed at treating psychiatric symptoms alone. Two patients required surgery while the other four required treatment with anti-epileptic drugs. All the patients had favorable response to the treatment of their epilepsy.

Conclusions:

This case series illustrates that epileptic patients may experience non-convulsive seizures that might be mistaken as primary psychiatric illnesses. In this subset of patients, evaluation by an epileptologist, MRI of the brain, and/or video-EEG telemetry in an EMU was necessary to confirm the diagnosis of epilepsy if routine EEGs and cranial CT are normal.

Résumé:

Résumé:Contexte:

Un diagnostic erroné peut être posé si des symptômes psychiatriques sont la manifestation de crises épileptiques ou si des patients atteints de maladies psychiatriques connues présentent des crises épileptiques.

Méthode:

Nous présentons le profil clinique de 6 patients atteints d’épilepsie, soit 3 hommes et 3 femmes dont l’âge moyen était de 39 ± 12 ans, qui ont consulté pour des symptômes psychiatriques évidents.

Résultats:

Deux patients avaient des maladies psychiatriques préexistantes. Un diagnostic d’attaques de panique a été posé initialement chez 3 patients, un diagnostic de psychose chez 2 et un diagnostic de schizophrénie chez 1. Cinq patients avaient une épilepsie temporale (ET) et un diagnostic d’état de mal épileptique non convulsif a été posé éventuellement chez le 6e patient. Chez 5 patients, la tomodensitométrie cérébrale avec agent de contraste n’a rien révélé, alors que chez le 6e patient cet examen a révélé la présence de changements post-traumatiques. L’IRM cérébrale a révélé la présence d’une tumeur neuroépithéliale dysembryoplasique (TNED) chez un patient, un hémangiome caverneux chez un patient et des changements post-traumatiques ainsi qu’une sclérose mésiotemporale bilatérale chez un autre patient. Cet examen était normal chez 2 patients atteints d’ET. On a dû avoir recours à la vidéo/télémétrie EEG au cours de la surveillance de l’épilepsie à l’unité de surveillance continue de l’épilepsie pour établir le diagnostic d’ET chez 4 patients. Aucun des patients n’a répondu aux médicaments ciblant seulement les symptômes psychiatriques. Deux patients ont dû subir une chirurgie alors que les 4 autres ont été traités au moyen de médicaments antiépileptiques. Tous les patients ont bien répondu au traitement de leur épilepsie.

Conclusions:

Cette série de cas illustre le fait que des patients épileptiques peuvent présenter des crises non-convulsives et qu’un diagnostic erroné de maladie psychiatrique primaire peut alors être posé à tort. Chez ce sous-groupe de patients, une évaluation par un épileptologue, l’IRM du cerveau et/ou la vidéo/télémétrie EEG dans une unité de surveillance continue de l’épilepsie peut être requise pour confirmer le diagnostic d’épilepsie si les EEG de routine et la tomodensitométrie cérébrale sont normaux.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 3 , May 2011 , pp. 487 - 493
Copyright
Copyright © The Canadian Journal of Neurological 2011

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