B - 41 Mild Head Injury (MHI), Unrelated Abnormal Brain Findings, Collateral Support, Video EEG and Neuropsychological Findings: a Case Study of Functional Seizure Disorder

Abstract Objective Functional seizure disorders, a form of conversion disorder with contributing biological, psychological, and social factors, pose a differential diagnostic challenge. Integrating video EEG, CT Brain Scan, collateral support and neuropsychological findings in diagnosis is discussed. Method The absence of epileptiform activity in video-EEG distinguishes functional and epileptic seizures. A case study is presented of a young adult male who sustained a MHI in a motor vehicle accident, presenting with a seizure disorder two weeks thereafter. Twenty-four-hour video EEG using photic stimulation revealed grunting sounds, head extension, clenched hands, back arching, jerking with associated paradoxical heavy breathing (shown in video clip), similar to family eyewitness descriptions. Hyperventilation was associated with generalized slowing. No epileptiform activity was noted. Unenhanced CT Brain Scan revealed global symmetrical age-incongruent cerebral involutional change. Results Neuropsychological assessment using CNS Vital Signs Test revealed variable scores, with “very low” scores on Complex Attention (raw score 17; SS = 68; 2nd Percentile); Cognitive Flexibility (raw score 28; SS =66; 1st percentile) and Processing Speed (raw score = 38; SS = 67; 1st percentile). “Above average” scores were found for Composite Memory (raw score 107; SS = 113; 81st percentile) and Verbal Memory (raw score = 59; SS = 122; 93rd percentile). Conclusions Brain involutional changes suggest pre-existing functional immaturity, instability of brain regions, or reduced neural connections may precede the diagnosis of Functional Seizure Disorders, precipitated by the MHI. In addition to video EEG, selected neuropsychological findings and collateral information provide additional support to confirm this complex disorder.