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The differential of nonepileptic seizures is broad, and even when spells are directly observed by skilled neurologists, errors in diagnosis are common.1 Differential diagnosis includes psychiatric illness, cardiac arrhythmia, autonomic dysfunction, and metabolic abnormalities. We report a patient presenting with refractory seizures, subsequently diagnosed with psychogenic nonepileptic seizures. She was later found to have physiologic nonepileptic seizures due to an insulinoma, which were completely controlled following surgical resection and treatment with diazoxide (Proglycem, Norton Pharmaceuticals, Miami, FL).
Case report.
A 45-year-old woman had a history of “panic attacks” consisting of inability to focus, tongue and/or limb tingling, perception of moving yellow spots, and cold sweat. She improved with relaxation and Zoloft and then developed episodic unresponsiveness and jerking. She was diagnosed with epilepsy and began carbamazepine. Episodes persisted, and video-EEG monitoring was performed. Similar spontaneous and induced (hyperventilation and placebo [saline] injection) events were recorded with no EEG change. She was diagnosed with psychogenic nonepileptic seizures. Events persisted …
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