Teche SP, Laporte P, Medeiros F, Bragatti JA and Gomes F
Dacrystic seizures are rare clinical occurrences characterized by paroxysmal stereotyped crying with a special challenging differential diagnosis with psychogenic non-epileptic seizures (PNES). We present a report of a male 21-yearold patient with history of schizophrenia, agitation crises and apparent seizures comprising a myriad of consciousness, motor, visual and autonomic manifestations. The patient began to smoke cannabis at age 15 and at age 18 smoked crack for 6 months. The seizures began at approximately this time and were incapacitating. In intercritical periods, he was friendly, communicative and displayed hysterical personality traits, but examination indicated no negative or positive symptoms when abstinent. Cognitive assessments revealed presence of intellectual deficiency (current QI=75). During hospitalization, the patient was extensively examined, and the diagnosis of schizophrenia was ruled out. All antipsychotic drugs were gradually tapered off. Video- EEG monitoring captured a prolonged seizure compatible with a dacrystic seizure. A cranial MRI scan revealed discrete diffuse cerebral atrophy. Carbamazepine was introduced and titrated until 1,600 mg/day and patient has been seizure-free for about 12 months. This case illustrates the importance of differential diagnosis of putative psychogenic seizures. This is the first report of dacrystic epileptic seizures associated with PNES and comorbid abuse of crack.
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