Firefighter With Co-Morbid Psychogenic Non-Epileptic Seizures and Post-Traumatic Stress Disorder Treated With Prolonged Exposure Therapy: Long-Term Follow-Up

Abstract

Psychogenic non-epileptic seizures (PNES), are events that resemble epileptic seizures but lack electrophysiological or clinical evidence for epilepsy. Instead, they are psychogenic in origin. These episodes tend to occur with alterations in consciousness and bodily functions and are the result of mechanisms of conversion. Psychological trauma and post-traumatic stress disorder (PTSD) are prevalent among patients with PNES. This is a case report of a 32-year-old male who began treatment 1-year after developing PTSD followed some months later by PNES. His seizures were characterized by contorted movements of the head and neck, guttural sounds, and left sided movements or whole-body arching and were accompanied by frequent falls and injuries. They were usually brief but occurred daily. Psychotherapy had been discontinued because violent seizures often interrupted the sessions. He was treated with prolonged exposure (PE) at a PNES program and by the last session, had achieved an improvement in his seizure frequency (one every 4–6 days rather than daily episodes). This allowed him to begin therapy with a local therapist. Two years after completing treatment, the patient returned for a follow up visit. At that point, his seizure frequency, was one per month which shows he sustained and improved on this symptom. Former head drops, and grunting sounds disappeared, and he was no longer using a cane to ambulate. From an emotional standpoint (PTSD, suicidality, anxiety, quality of life), the patient had achieved and maintained a much healthier level of functioning (though no change on alexithymia, anger, depression, and trait anxiety).