The Use of Carbamazepine in the Management of Psychogenic Nonepileptic Seizures (PNES)

Psychogenic nonepileptic seizures (PNES) is a conversion disorder subtype that cause motor, sensory, autonomic, and cognitive symptoms that superficially resemble ictal epileptiform activity but without the electroencephalographic (EEG) activity that defines epilepsy. While 10-20% of patients referred to epilepsy centers are estimated to have PNES (1), diagnosing the condition is labor intensive as it requires seizure-like behavior observed during EEG monitoring. However, accurate diagnosis is essential as psychopharmacologic interventions have been shown to have limited utility in reducing seizure-like activity in PNES (2). Instead, case reports and small randomized clinical control trials have shown cognitive behavioral therapy (CBT) effective (3), and it is considered main stay of treatment. We present the case of a 37-year-old woman who presented to our clinic with symptoms of depression including hypersomnia and anhedonia. Her most distressing symptoms were episodes of abnormal movements and shaking without loss of consciousness. She has a past medical history notable for EEG-confirmed PNES, major depressive disorder with psychotic features, generalized anxiety disorder, clipped-intracranial aneurysm. She had been taking Duloxetine for major depressive disorder and fibromyalgia, and Carbamazepine was initiated to manage abnormal movements and her depressive symptoms. She reported improvement in the frequency and severity of abnormal movements after initiating Carbamazepine. Unfortunately, her depression worsened, and she was admitted to the inpatient unit for suicidal ideation and auditory and visual hallucinations commanding her to end her life. She was initiated on Aripiprazole. She was admitted for four days and was discharged after she demonstrated improvement in mood and severity of auditory hallucinations. Funding No Funding