Failure to recognize psychogenic nonepileptic seizures may cause death

A 17-year-old boy presented for the first time with frequent seizures. Attacks consisted of nausea followed by flashing purple images, loss of consciousness, collapse, and bilateral shaking. The diagnosis of epilepsy was thought doubtful from the outset, but anticonvulsants were prescribed. Brain MRI showed no abnormalities. Based on inpatient observation on a neurology ward, ictal EEG and video-EEG of spontaneous typical seizures with apparent loss of consciousness, but no epileptiform activity or postictal changes, a firm diagnosis of nonepileptic attack disorder was made within 3 months of the manifestation of seizures. During his time on the ward, the patient was seen to be studying medical textbooks. On one occasion, he stole and altered his medical charts. He failed to engage in psychotherapy but was admitted to at least 11 different hospitals in his home region with 37 episodes of prolonged seizures over 3 months. Following …