A case study of managing functional seizures and self-injurious behavior in a detention setting: A multidisciplinary approach

Functional seizures, also known as psychogenic nonepileptic seizures (PNES), present a significant challenge in correctional settings, where stress and limited medical resources complicate management. This case study explores the evaluation and treatment of a 20-year-old man detainee with functional seizures and comorbid borderline personality disorder (BPD). Initially misdiagnosed with epilepsy and schizophrenia, he underwent extensive medical evaluations and hospitalizations, including intubation following a seizure episode. His history of self-injurious behaviors, particularly swallowing foreign objects, further complicated his care. A multidisciplinary approach was implemented, including gradual withdrawal of unnecessary antiseizure medications, targeted treatment of BPD symptoms with quetiapine, and intensive therapeutic engagement. Structured interactions, emotional regulation strategies, and nonpharmacological interventions were emphasized. Over time, the patient demonstrated significant improvement, with cessation of self-harming behaviors and a reduction in seizure episodes. This case highlights the complexities of managing functional seizures in detention centers and the importance of accurate diagnosis, individualized treatment plans, and the integration of psychiatric and behavioral interventions. A therapeutic environment, combined with appropriate pharmacologic and nonpharmacologic strategies, can lead to meaningful clinical improvements in patient with PNES and co-occuring personality disorders.