A 24-year-old woman has recurrent episodes of limb shaking lasting several minutes. Video-EEG during a typical episode shows no epileptiform discharge. During the event her eyes are tightly shut, the shaking fluctuates in amplitude, she turns her head side to side, and she has no postictal confusion. Serum prolactin measured after the episode is normal. What is the MOST likely diagnosis?
- A Frontal lobe epilepsy
- B Generalised tonic-clonic epilepsy
- C Psychogenic nonepileptic seizure ✓
- D Catatonic excitement
Correct answer: C. Psychogenic nonepileptic seizure
Explanation
Prolonged duration, eyes closed, side-to-side head turning, fluctuating motor activity, absence of postictal confusion, a normal ictal EEG, and normal postictal prolactin are classic for psychogenic nonepileptic seizures. Frontal lobe seizures are brief, occur from sleep, have stereotyped clonic jerks, and show ictal changes on EEG. Generalised tonic-clonic seizures last under two minutes, have eyes open, and cause marked postictal confusion with elevated prolactin.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.