Reported cases of nonconvulsive status epilepticus (NCSE) of frontal origin with fear as the main clinical expression are extremely rare in the literature and often in daily activity could be misinterpreted as psychiatric disorders. We reported a right-handed 36-year-old-man with focal drug-resistant epilepsy characterized by recurrent and subtle complex partial seizures, in which fear was the main clinical manifestation, misdiagnosed as psychogenic non-epileptic seizures. Long-term video-EEG monitoring showed prolonged (lasting about 30-40 min) and self-limited episodes clinically characterized by fear, psycho-motor agitation and crying while EEG showed continuous, rhythmic spike activity prevalent over the left frontal region. Ictal 99mTc-ECD SPECT demonstrated increased focal perfusion of left frontal (mainly) and occipital cortex while the inter-ictal phase showed a reduced perfusion in the left hemisphere, mainly of frontal and occipital cortex. The correlation of long-term video-EEG monitoring and SPECT is useful to detect the abnormal brain region not only in searching for the epileptic focus in the case of presurgical epilepsy evaluation but also in assessing the diagnosis of a prolonged paroxysmal event as status epilepticus, which may be clinically unclear and often misdiagnosed as psychiatric disturbances.
|Translated title of the contribution||Fear as nonconvulsive status epilepticus of frontal origin: EEG-SPECT correlation|
|Number of pages||4|
|Journal||Bollettino - Lega Italiana contro l'Epilessia|
|Publication status||Published - Apr 2013|
ASJC Scopus subject areas
- Clinical Neurology