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Nikolaev E.E., Orlov F.V., Nikolaev E.L., Velilyaeva A.S., Khayatov R.B.
The Phenomenon of Simulating Seizures in Epilepsy: Case Report
Keywords: epilepsy, psychogenic non-epileptic seizures, factitious disorder, simulation, conversion disorder, personality-oriented psychotherapy
Psychogenic non-epileptic seizures may resemble epileptic ones, but bioelectric activity is not recorded on the electroencephalogram. In some cases, psychogenic non-epileptic seizures and epilepsy are diagnosed simultaneously. The frequency of epilepsy in patients with diagnosed psychogenic non–epileptic seizures is 22%, and the incidence of psychogenic non-epileptic seizures among patients with epilepsy is 12%. The article describes a clinical case of a patient with diagnosed epilepsy, in whom psychogenic non-epileptic seizures were detected simultaneously with epileptic seizures. Polymorphic non-convulsive and convulsive seizures were observed in the clinical presentation. The patient received anti-epileptic therapy in high doses for a long time without significant effect. Convulsive seizures in most cases occurred during the day in crowded places in the presence of people. Most often, the patient managed to attract the attention of others and ask for help. A pathopsychological examination revealed a pronounced sharpening of hysteroid and epileptoid traits with excessive fixation on the state of the patient's health. For the first time in years of being treated by different doctors, the patient admitted during psychotherapy that convulsive seizures that occur with her are "useful". It was advantageous for her to take on the role of a person out of health in order to protect herself from her husband's aggression and get sympathy, feel special, get rid of extra burden at work. The article provides a differential diagnosis between factitious disorder, conversion disorder, simulation and aggravation. It is concluded that convulsive seizures in the patient occurred by the mechanism of a factitious disorder. The following facts speak in favor of this: motivation for this behavior is not clear to others and is of an internal nature, the desire to accept the role of a person out of health, awareness of seizures "usefulness", lack of attention in the family, hysteroid character traits. It is concluded that for the successful treatment of comorbidity conditions of psychogenic non-epileptic seizures and epilepsy, close interaction of a neurologist, a psychiatrist, a psychotherapist and a psychologist is extremely important.
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About authors
- Nikolaev Egor E.
- Resident, Department of Psychiatry, Medical Psychology and Neurology, Chuvash State University, Russia, Cheboksary (nikegev@bk.ru; ORCID: https://orcid.org/0000-0002-2774-4443)
- Orlov Fedor V.
- Candidate of Medical Sciences, Associate Prodessor, Department of Psychiatry, Medical Psychology and Neurology, Chuvash State University, Russia, Cheboksary (orlovf@yandex.ru; ORCID: https://orcid.org/0000-0002-8772-4428)
- Nikolaev Evgenii L.
- Doctor of Medical Sciences, Professor, Head of the Department of Social and Clinical Psychology, Chuvash State University, Russia, Cheboksary (pzdorovie@bk.ru; ORCID: https://orcid.org/0000-0001-8976-715X)
- Velilyaeva Alie S.
- Candidate of Medical Sciences, Associate Professor, Head of the Department of Psychiatry, Samarkand State Medical University, The Republic of Uzbekistan, Samarkand (alsabvel@mail.ru; )
- Khayatov Rustam B.
- Assistant of the Department of Psychiatry, Medical Psychology and Narcology, Samarkand State Medical University, The Republic of Uzbekistan, Samarkand (xayatov.rustam@gmail.com; )
Article link
Nikolaev E.E., Orlov F.V., Nikolaev E.L., Velilyaeva A.S., Khayatov R.B. The Phenomenon of Simulating Seizures in Epilepsy: Case Report [Electronic resource] // Acta medica Eurasica. – 2023. – №3. P. 102-115. – URL: https://acta-medica-eurasica.ru/en/single/2023/3/11/. DOI: 10.47026/2413-4864-2023-3-102-115.