AbstractWe describe two patients with psychogenic seizures of rare semiology. Both patients (a 23-year-old man and a 26-year-old woman) attended the emergency department because status epilepticus with myoclonic seizures had been diagnosed. Seizures were documented with video-electroencephalography. Semiology of seizures were brief myoclonia of both arms resulting in a short elevation of both arms without impairment of consciousness. Ictal EEG registration was without abnormal finding. Psychiatric diagnostic assessment suggested a dissociative disorder and mild depression, respectively. During psychiatric treatment seizures occurred only rarely within a 3–5 months follow-up. One should be aware that juvenile myoclonic epilepsy may be mimicked by psychogenic seizure

Bauer, J.

Elger, C.E.

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Psychogenic seizures mimicking juvenile myoclonic epilepsy: case reports 

doi:10.1053/seiz.2000.0488, available online at http://www.idealibrary.com on
Seizure 2001; 10: 208–211
CASE REPORT
Psychogenic seizures mimicking juvenile myoclonic
epilepsy: case reports
J. BAUER & C. E. ELGER
Department of Epileptology, University of Bonn, Germany
Correspondence to: Dr J. Bauer, Universita¨tsklinik fu¨r Epileptologie, Sigmund Freudstr. 25, D-53105 Bonn, Germany
We describe two patients with psychogenic seizures of rare semiology. Both patients (a 23-year-old man and a 26-year-old
woman) attended the emergency department because status epilepticus with myoclonic seizures had been diagnosed. Seizures
were documented with video-electroencephalography. Semiology of seizures were brief myoclonia of both arms resulting in a
short elevation of both arms without impairment of consciousness. Ictal EEG registration was without abnormal finding. Psy-
chiatric diagnostic assessment suggested a dissociative disorder and mild depression, respectively. During psychiatric treatment
seizures occurred only rarely within a 3–5 months follow-up. One should be aware that juvenile myoclonic epilepsy may be
mimicked by psychogenic seizures
c© 2001 BEA Trading Ltd
Key words: psychogenic seizures; juvenile myoclonic epilepsy; status epilepticus; depression.
INTRODUCTION
Semiology of psychogenic seizures is markedly vari-
able. Most common is a seizure type with unrespon-
siveness, drops and frequent jerks1, 2. We investigated
two patients who both presented frequent myoclonic
seizures mistaken for juvenile myoclonic epilepsy3.
Both patients were treated as emergency cases at the
Department of Epileptology, University of Bonn, be-
cause seizures occurred frequently and status epilep-
ticus with myoclonic seizures had previously been
diagnosed.
MATERIALS AND METHODS
Case reports
Case report 1
Patient 1 was a 23-year-old man suffering from
seizures since the age of 20 years. He experienced
seizures with myoclonia, lasting for seconds and
causing a brief abrupt movement of both arms and
(sometimes) legs without impairment of conscious-
ness. There was a varying frequency of seizures with
daily seizure clustering as well as periods of days with-
out seizure manifestation. Seizure occurrence was not
temporally related to the hours following awakening.
Neurological investigation, cranial computed tomog-
raphy and interictal electroencephalography (EEG)
were normal. There was no family history of epilepsy.
The patient had received lamotrigine (increased up
to 700 mg per day) without influencing seizure fre-
quency.
The patient attended the hospital because status
with myoclonic seizures had been diagnosed. Seizure
frequency had increased a week before attendance.
Seizures were documented by simultaneous video-
electroencephalographic and electrocardiographic
registration (video-EEG): seizures showed brief my-
oclonia resulting in a short elevation of both arms.
Consciousness was not impaired. The ictal EEG did
not show epileptic discharges (Fig. 1). Psychogenic
seizures were assumed, lamotrigine was tapered. The
patient was referred to the Department of Psychiatry,
University of Bonn, where a dissociative disorder was
diagnosed. Opipramol was administered, psychother-
apy was initiated. During 5 months follow-up only a
few seizure attacks were reported by the patient.
1059–1311/01/030208 + 04 $35.00/0 c© 2001 BEA Trading Ltd
Psychogenic myoclonic seizures 209
Fig. 1: Video documentation of a seizure in patient 1. Brief symmetric myoclonia of both arms. The electroencephalogram
documents movement artifacts.
Fig. 2: Video documentation of a seizure in patient 2 demonstrating brief symmetric myoclonia. Consciousness was not impaired.
210 J. Bauer & C. E. Elger
Case report 2
Patient 2 was a 26-year-old woman suffering from
seizures since the age of 12 years. During the first
years of the disease seizures occurred once every 3
to 4 months. Stress was a common precipitating fac-
tor. Seizure occurrence was not temporally related to
the hours following awakening. There was no family
or personal history of epilepsy.
Fig. 3: Ictal electroencephalogram (EEG) during a seizure in
patient 2. The EEG did not show an abnormal finding. During
a seizure (arrow) movement artifacts are registered.
The patient attended the hospital because status
with myoclonic seizures had been diagnosed. Seizure
frequency had increased 10 days before attendance.
Treatment with valproate (450 mg per day) had been
without impact on seizure frequency.
Neurological examination was without abnormal
finding. Seizures were documented by video-EEG:
seizures showed brief myoclonia resulting in a short
elevation of both arms (Fig. 2). Consciousness was
not impaired. The ictal EEG did not show any epilep-
tic discharges (Fig. 3). Psychogenic seizures were
diagnosed, valproate was tapered. The patient was re-
ferred to the Department of Psychiatry, University of
Bonn. Mild depression was diagnosed and psychother-
apy was initiated. Sertalin was administered. During a
3-week treatment as an in-patient myoclonia were ob-
served only once. Three months after the emergency
treatment the patient did not report any seizures. Her
depression was in remission.
Informed consent has been obtained from both
patients before video documentation of seizures was
carried out. Both patients agree with the publication of
the video-documentation of their seizures in a medical
journal and have given their written consent.
DISCUSSION
There are no phenomena that occur solely and ex-
clusively in epilepsy4. Phenomena observed during
epileptic seizures also can be a feature of psy-
chogenic attacks. The most usual symptoms of psy-
chogenic seizures consist of unresponsiveness or sud-
den paroxysmal changes in affect or behaviour; con-
vulsions may occur5. However, brief bilateral myoclo-
nia without impairment of consciousness seem to be
rare and have never previously been observed by us6.
Not surprisingly, these currently described seizures
were mistaken for epilepsy and were treated without
any effect with valproate or lamotrigine.
In both patients the frequency of seizures had in-
creased before attendance and status epilepticus was
diagnosed. Patients with psychogenic seizures may
have prolonged attacks and sometimes are admitted
to emergency facilities in status epilepticus7. Inter-
estingly, status epilepticus with myoclonic seizures is
hardly ever described in patients suffering from juve-
nile myoclonic epilepsy8–10.
In patients with psychogenic seizures associated
psychiatric disorders have been described: somato-
form disorders, dissociative disorders, affective disor-
ders, personality disorders, post traumatic stress dis-
order, and other anxiety disorders1, 11. In the patients
reported here, dissociative disorder and depression, re-
spectively, was diagnosed. Psychiatric treatment led to
a nearly complete cessation of seizures during the 3–5
months follow-up.
In conclusion, symptomatology of the seizures ob-
served in both patients document that even juvenile
myoclonic epilepsy may be mimicked by psychogenic
seizures, however, obviously this is a rare semiology
of psychogenic seizures.
ACKNOWLEDGEMENT
Dr Marcella Rietschel, Department of Psychiatry, Uni-
versity of Bonn, provided the psychiatric assessment
of the patients.
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Psychogenic seizures mimicking juvenile myoclonic epilepsy: case reports

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