Affiliations: Pediatric Intensive Care Unit, Department of
Pediatrics, Catholic University, Rome, Italy
Note: [] Correspondence: Arianna Langer, M.D., Pediatric Intensive Care
Unit, Department of Pediatrics, A. Gemelli Hospital Largo A. Gemelli, 8, 00168
Rome, Italy. Tel.: +39 063 0155203; E-mail: arylanger@tiscali.it
Abstract: Pseudoseizures (PS) resemble epileptic seizures. They are strictly
linked to personality disorders and may involve all ages, with a higher
incidence during adolescence. Patients experience episodes of loss of
consciousness, twitching or jerking, and unusual emotional states, such as
intense feelings of fear or "déjá vu". The episodes may last 20 minutes,
but unlike epileptic seizures, they are not associated with electrical
abnormalities in the brain. Even for trained medical professionals,
differentiating epileptic seizures from PS is difficult. Physicians believe PS
are psychological defense mechanisms induced by stress or episodes of severe
emotional trauma; in fact, they tend to occur when patients try to avoid or
forget the trauma. Twenty percent of patients with seizures are ultimately
diagnosed with PS but the diagnosis is difficult to make on the first
examination. Patients with PS are often referred to the Emergency Department
because of their poor response to conventional anticonvulsant drugs. Due to the
apparently critical condition of these patients on presentation, they are often
referred to a Pediatric Intensive Care Unit (PICU) and may be over-treated
during their difficult and long diagnostic course. We report two cases admitted
to our PICU for apparent status epilepticus, in which the final diagnosis was
PS.
Keywords: pseudoseizures, pediatric intensive care unit, status epilepticus, adolescence
