Résumé
We report a case of loss of consciousness multiple times with and without focal to bilateral tonic-clonic seizure-like episodes that we diagnosed as psychogenic non-epileptic seizures, and successfully treated with shigyakusan and hangebyakujutsutemmato. The patient did not have fullness and discomfort in the chest and hypochondrium (kyokyokuman), nor spasmodic bilateral rectus abdominis in an interictal state. On the other hand, she had extremely cold limbs, especially feet and hands, with fingers being flexion and rigid under the status of loss of consciousness even without tonic-clonic seizure-like episodes in the ictal state. After being warmed and loosened, her consciousness level slowly recovered. She had headaches frequently in a non-ictal state, too. We identified that she had qi deficiency (kikyo), qi depression (kiutsu), fluid retention (suitai) and qi counter flow (kigyaku) in the interictal state, while kiutsu and kigyaku were extremely strong in the ictal state. In this case, the combined use of shigyakusan and hangebyakujutsutemmato was useful, considering that the patient had two different locations of disease (byoi) that required treatment.
Résumé
Background: Psychogenic Non Epileptic Seizure (PNES) is one of the most common conditions to be mistaken for epilepsy. No clinical feature is pathognomic of PNES, but some help in distinguishing it from epileptic seizure. Role of psychologically stressful events has been considered central to the pathogenesis of PNES and used in differentiating it from epileptic seizure. The purpose of present study was to compare the clinical profile and number of stressful life events in the two patient groups in Indian population. Methods: 50 new patients of epileptic seizure and PNES each, aged 16 to 60 visiting the psychiatric and neurology OPD were selected. Detailed history and physical examination was carried out to exclude any medical illness. Diagnosis was made based on clinical history given by an eye witness and EEG recording. Brain imaging (CT/MRI) was conducted, to rule out any secondary causes of seizure. General health questionnaire 12, and presumptive stressful life event scale was applied on all patients. SPSS 19 was used for data analysis. Chi square was used for categorical data and Man Whitney U test for continuous data. Results: There were significantly more females in the PNES group (P = 0.001) and significantly more illiterate (P = 0.004) .There were no significant difference with regard to the age of onset, marital status. Also there was no statistically significant difference between the two group with regard to number of stressful life event (P = 0.330). Conclusion: Stressful life event should not bias a clinician towards making a diagnosis of PNES.