A 25 year old female patient history of 6 months, altered sensorium, involuntary rnovements,memory deficit, headache convulsions, abnormal movements, forgetfulness, 4 attack during day, 2 attack at night. CT normal :
Epilepsy It is a case of epilepsyTwo features our the diagnosis of epilepsy:-Presence of altered sensoriumOccurrence of epilep.sy during sleepDissociation disorders may resemble epilepsy, especially complex paial seizure.Dissociative disorders are a group of psychiatric syndromes characterized by disruptions of aspect of consciousness, identity, memory, motor behaviour or environmental awareness.They may resemble epilepsy in presentation but an impoant feature of these disorders is that the patient is always ale and oriented.Two impoant ways to rule out organic epilepsy from psychogenic epilepsy are:-i) Abnormality in E.E.G.- Generalized tonic clonic seizures always produce marked E.E.G. abnormalities during and after the seizure.ii) Increase in prolactin secretion- Measurement of serum prolactin levels may also help to distinguish between organic and psychogenic seizures, since most generalized seizures and many complex seizures are accompanied by rise in serum prolactin.Amnesia can occur in ceain epilepsies (complex paial seizures)Complex paial seizures are characterized by foal seizure activity accompanied by a transient impairment of the patient's ability to maintain normal contact with the environment (altered sensorium)The patient is unable to respond appropriately to visual or verbal commands during the seizure and has impaired recollection or awareness of the ictal phase.Examination immediately following the seizure may show an anterograde amnesia (memory deficits) or in cases involving the dominant hemisphere, a postictal aphasia.Other two options can be easily rule outSomatization disorderIn these cases patient will compain of number of symptoms involving multiple organ .system of the body.Hypochondriasis In lzypochondriasis patient complains that he has some serious ailment and he consults many dotors.
Epilepsy
Dissociative disorder
Hypochiondriasis
Somatization disorder