18 Year Old Female With Convulsions After Getting Hit In Head By Volleyball. - Page #4
 

Working Diagnosis:
Psychogenic paroxysmal non epileptic event sparked by migraine

Treatment:
Given rizatriptan with resolution of seizures within fifteen minutes. Held from physical activity until further evaluation by neuropsychiatry and neurology. Celexa and vyvanse were continued.

Outcome:
Re-evaluated by neurology, as well as neuropsychiatry, confirming underlying medical history of migraines and acute psychogenic seizure. Symptoms were not thought to be due to new/repeat concussion. Rather, the symptoms were thought to be due to patient fearing return of concussion-like syndrome after being hit in the head and experiencing mild headache. She was continued on treatment for underlying ADHD and depression. In addition, rizatriptan was continued as needed for migraine headaches. Patient returned to full physical activity following standard return-to-play protocol.

Author's Comments:
Management of concussions can be very difficult, especially when suffering from neurocognitive symptoms. It is important that providers be aware of alternate diagnoses that may be masked by underlying symptoms.

References:
1. Benbadis SR. How many patients with pseudoseizures receive antiepileptic drigs prior to diagnosis. Eur Neurol. 1999;41:114-115.
2. Krumholz A, Niedermeyer E. Psychogenic seizures: a clinical study with follow-up data. Neurology. 1983;33:498-502.
3. Gokce NS, Haydar AT, Hulya I. Semiological and psychiatric characteristics of children with psychogenic nonepileptic seizures: Gender-related differences. Seizure. 2015;31:144-148.

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