Psychiatric disorders secondary to nonconvulsive status epilepticus of frontal origin. Two clinical case reports

Abstract

Nonconvulsive status epilepticus (NCSE) is common but often under-diagnosed. Due to the absence of specific symptoms, it is frequently misdiagnosed as a psychiatric disorder, which delays treatment. The cases of two patients who exhibited psychiatric symptoms and subtle cognitive disturbances (without confusion) as the sole manifestation of frontal lobe NCSE are reported. Both patients were initially treated as psychiatric disorders (depression and anorexia nervosa). The correct diagnosis was established by the electroencephalographic study, in one case after the patient experienced a generalized tonic-clonic seizure and in the other, after failure to improve with supposedly adequate treatment. There are reports of patients with NCSE whose symptoms suggest a psychiatric disorder (inappropriate behavior, emotional disinhibition, perseveration, reduced speech and motivation). This can occur without altered consciousness and symptoms may fluctuate, making the correct diagnosis extremely difficult. This entity can occur at any age and without a previous history of seizures. A high level of suspicion is necessary for prompt electroencephalographic study to confirm the diagnosis. Early treatment will correct the symptoms and significantly improve quality of life for patients and their families.