The squeezing snake, a psychiatric presentation of epilepsy: A case report

Abstract

Introduction

Epilepsy is considered a complex neurological disorder with a great variety of clinical presentations that can resemble psychiatric disorders.

Objectives

Disclose an unusual clinical case with psychiatric symptoms as the presentation of epilepsy.

Methods

Psychiatric assessments and retrospective review of the clinical file and literature research.

Results

A 40-years-old Romanian woman presented to the psychiatry outpatient service with a history of persistent depressive mood and disturbed sleep for the past 3 years, complaining of a feeling that she described as “a snake squeezing around her body, starting in her left leg and spreading to the rest of her body up to the neck” associated with a sense of pins and needles, occurring during night time. She attended general practice, neurosurgery and psychiatry appointments. Her medical history included “gastritis” and lower left leg fracture and a pituitary microadenoma revealed in brain CT-scan. Blood work, including endocrine tests and brain-MRI were normal. Her symptoms initially led to diagnosis of: anxiety, somatization, Ekbom syndrome and depression. She was treated with antidepressives, antipsychotics and anxiolytics, without response. After careful reconstruction of the clinical history and further analyses of her complaints, the diagnosis of focal sensory jacksonian seizure was made. Levetiracetam introduction led to symptomatic remission.

Conclusion

Epilepsy includes a variety of neuropsychiatric symptoms. This case illustrates that epileptic patients may experience non-convulsive seizures that might be mistaken as primary psychiatric disorders. Neurologists and psychiatrists must be aware of this varied presentation while obtaining the medical history in order to investigate and manage this patient effectively.

Disclosure of interest

The authors have not supplied their declaration of competing interest.