Teaching Video NeuroImages: complex partial seizure evolving into a psychogenic nonepileptic seizure.

An 11-year-old, right-handed girl was admitted for video-EEG monitoring of nocturnal paroxysms consisting of eye opening, groans, right arm shaking, and altered consciousness (see video on the Neurology Web site at www.neurology.org). Ictal video-EEG suggested a left frontal seizure; subsequent behavioral disturbances including dysrhythmic right arm shaking and confusion continued without electrographic correlate (figure). Although epileptic and nonepileptic seizures frequently coexist, this case illustrates the rare direct evolution of a complex partial epileptic seizure into a nonepileptic seizure and highlights the importance of video-EEG monitoring in discerning epileptic from nonepileptic events.1 Ictal activation or disinhibition of emotional neural circuitry is one proposed mechanism for this phenomenon.