ABSTRACT
We experienced two cases of complicated pseudoseizure, whose diagnosis and treatment were based on Kretschmer's concept of "primitive hysteria". The first case was a 16-year-old boy who experienced a convulsion before a swimming class which he disliked. He was immediately brought to the emergency department of our hospital. Initially, he was treated as a true epileptic patient, and his convulsion continued for hours. We monitored the patient by video, which aided in making a precise diagnosis. He also showed a pain disorder. The second case was a 16-year-old girl who developed hyperventilation and convulsion during her graduation ceremony. The characteristics of her convulsion were similar to the first case. Four days after her admission to our hospital, we concluded that her symptoms were a part of primitive hysteria. After her discharge, she experienced some intermittent episodes of convulsion. There was also a possibility of sexual abuse from her father. Both patients had a family history of mental retardation and an unstable home life, as well as similar symptoms. Even in a modern general hospital, there is a lack of understanding about pseudoseizure, thus, medication may be unnecessary for undiagnosed patients. DSM-IV-TR as well as ICD-10 criteria do not mention anything about primitive hysteria. However, we recommend revitalization of this concept because it is a useful, appropriate, and necessary description of pseudoseizure with complications.
