Conversion disorder misdiagnosed as epilepsy for 12 years, treated successfully with fluoxetine - Case report

Abstract

Background:

This case report suggests that Conversion Disorder may take years to become evident, so this diagnosis may place the clinician in difficulties and sometimes in misdiagnosis.

Method and results

A 39 years old woman admitted in Neurology Department (September 2005) to determine the nature of her seizures and other motor symptoms. The first symptoms appeared 12 years ago after marital conflicts. Some days later she presented motor symptoms such as, impaired coordination and balance, “epileptic” seizures and convulsions. She was diagnosed as suffering from Epilepsy and was treated with antiepileptic drugs for many years. During last year she presented a variation of motor symptoms, seizures, convulsions and some sensory symptoms, loss of touch (in the left side of the body), and because of instability. Neurological and laboratory examinations ruled out neurological disorders including epilepsy (normal EEG and CT). Psychiatric consultation followed.We realized that our patient met the diagnostic criteria (DSM-IV) for conversion disorder. Gradually, we discontinued antiepileptic drugs and began to treat with fluoxetine at maximum dose 40mg/day. Three months later she was released from previous symptoms, so we continued to treat with 20 mg/day for ten subsequent months. At present days she lives without motor or sensory symptoms. The patient has provided us with a video registration of her “crisis” recorded by her brother.

Conclusions:

The clinicians should raise the awareness about this diagnosis. They have to be careful and improve knowledge about treatment and diagnostic techniques.