A Rare Case of Psychogenic Nonepileptic Seizure Following Transcranial Magnetic Stimulation

Psychogenic nonepileptic seizures (PNES), also referred to as functional seizures, are events that mimic epileptic seizures but are not triggered by abnormal electrical activity in the brain. According to the International Statistical Classification of Diseases (ICD)-11, PNES are classified as dissociative disorders. Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation therapy commonly used to treat major depression, particularly in cases where other treatments have not been effective. PNES has not been associated with TMS previously. Here, we describe a 52-year-old Caucasian male who presented to the acupuncture clinic with multiple episodes of sudden loss of consciousness following TMS for a long history of major depression. The episodes of unconsciousness occurred up to five times per day. During an electroencephalograph (EEG) session, the patient had an episode that included poor balance, "shaking," head nodding, and a robotic/slowed voice, although no epileptic activity was captured on EEG. His illness was therefore diagnosed as PNES activity. He underwent treatment with body acupuncture and auricular acupressure and improved, with reduced number and duration of episodes. PNES following TMS has not been reported previously. A strong magnetic field can potentially disrupt normal neurotransmission and neuronal metabolism, resulting in PNES. The beneficial effects of acupuncture have been documented, but the mechanism of action has not been elucidated.