Movin' And Shakin'; An Investigation Of Seizure Like Activity

HISTORY: 19-year-old female NCAA soccer player with recent labral tear status post repair presented on 8/27 to clinic feeling nauseated and was noted to have a witnessed seizure lasting 2 minutes.911 called, and JS transported to the ED where workup unremarkable other than mild hypokalemia.JS noted having a similar episode on 8/24, but this wasn't reported. Neurology consulted and discharged on Levetrecitam for new onset seizure.JS denied family history of seizure but noted increased stress related to hip surgery, long rehab and team tension during a losing season.JS had further episodes prompting three additional ED visits and eventual admission with unremarkable workup. JS referred to Neurology for concern of seizure versus Psychogenic Non-Epileptic Seizure. Levetrecitam dose was decreased, inpatient EEG was completed and normal and vEEG was recommended. PHYSICAL EXAMINATION: General:Tired female.Cardiac: RRR, no MRG.Psych: AAOx3, flat affect.Concentration, comprehension and speech normal.Neuro: CN II: PERRLA to light. Visual fields full to confrontation,CN III/IV/VI: EOMI,CN V:Facial sensation intact to light touch bilaterally,CN VII:Facial expressions full and symmetric,CN VIII:Hearing intact,CN IX, X:Uvula midline, palate raised symmetrically,CN XI:SCM full strength bilaterally,CN XII:tongue protrudes midline.Motor exam:no drift.Strength 5/5 in bilateral upper and lower extremities,Reflexes: 2+ in upper and lower extremities,Sensation: equal to light touch in all extremities.Coordination:negative finger to nose, gait non antalgic DIFFERENTIAL DIAGNOSIS: Seizure Disorder,Psychogenic Non-Epileptic Seizure,Panic Attack,Syncope TEST AND RESULTS: CT Head:no acute intracranial process,MRI Brain:no acute intracranial process,Spot EEG: normal,2 hr EEG:normal.Labs: mild hypokalemia,UDS + Benzodiazepine, EKG: RRR FINAL WORKING DIAGNOSIS: Psychogenic Non-Epileptic Seizure TREATMENT AND OUTCOMES: Started on Levetiracetam given concern for new onset seizure.Dose was adjusted given breakthrough incidents.Per Neurology,JS continues to take Levetiracetam and to date, JS has not had another seizure episode.vEEG scheduled on 11/25.Individualized EAP created to ensure her safety.JS continues sports psychology follow up and hip rehab but has not returned soccer