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Pseudoseizures (PMP/OSCE)

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Question:

In this station you are talking to a neurologist over the phone about a 49 year old man who works part time as a secretary in an office. This married lady has a history of occasional strange epsisodes for approximately a year but quite recently there has been an increase in the frequency of these episodes. The investigations performed so far are inconclusive which include EEG, MRI, and post-episode serum prolactin levels.

In each episode the lady goes blank all of a sudden whilst talking to soemebody, loses her coordination and falls asleep. On awakening, she can't recall anything of the incident.

She has a history of postnatal depression 24 year ago on birth of her daughter. The lady has always been a worrior and recently she remains more and more tearful even at her work place for no apparent reason.

How will you asssess and manage this patient. Describe your management plan to the neurologist.

Answer:

Key Issues:

Key issue here are to reach a diagnosis and to differentiate between psudo- and true seizures

Assessing any risk she poses to herself or others.  (added)

and lastly managing these episodes.

Please proceed with further discussion

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there are some discrepancies but i will give it a go :-/

issues

- establishing the underlying diagnosis for her presentation.

- assessing any risk she poses to herself or others.

- advicing on management.

DD

substance misuse disorder

true seizure due to brain injury

psychotic disorder

hypomania

agitated depression

psudoseizure

conversion disorder

I need to get as much information from as much sourses as possible. this includr GP, Mental health records, details of the depressive episode after delivery and neurology department.

proceed to see the patient in outpatient clinic with some who had witnessed the episodes. i will take a comprehensive history and do a mental state examination. including past psychiatric history, od, selfharm or suicide, history of assulting others during her episodes. medical history and check the results of any investigation done before i.e eeg/mri. also to check if the prolactin level was taken within 20 minutes of an episode and wat was it.

depending on the above either their is a physical problem or I will go down the rout of psudoseziure. in this case I would reassure the patient that fortunately there are no physical cause for his illness and that the treatment will be through psychological therapy CBT/IPT. also I will involve the multidicplinary team with regards to social circumstance,accommodation etc :-[

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Narcolepsy with Cataplexy would be a DD I guess...

Losing coordination and suddenly falling asleep... SOREMS would show on EEG... only if you do a sleep study... so I sud suggest a sleep study...

By the way... Is there a diagnosis called Pseudoseizures??? There is no diagnosis of pseudoseizure in DSM 4... I am not really sure of ICD 10...

According to DSM, it would be Conversion disorder...

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hi dorian

I think narcolepsy would be a valid DD.

seizure and pseudoseziure are medical terms both not on ICD10. and conversion is a definte DD :-*

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