Conversion disorder: Not a malingering matter.

The Canadian Paediatric Surveillance Program (CPSP) is a joint project of the Canadian Paediatric Society and the Public Health Agency of Canada, which undertakes the surveillance of rare diseases and conditions in children and youth. For more information, visit our website at www.cps.ca/cpsp. A 12-year-old girl was seen by her family physician with a chief complaint of seizures. Over the past several weeks, she has suffered from attacks of bilateral arm jerking, followed by bilateral leg jerking. Often, her head shakes violently from side to side and her eyes are seen to roll back in her head. These spells are not accompanied by bladder or bowel incontinence, but often the patient bites her tongue and kicks over tables or strikes family members during an episode. These incidents typically follow episodes of emotional outburst and can wax and wane for 20 min to 30 min with varying intensity. She has no significant medical history and takes no medications. Her school performance is excellent. She is a competitive gymnast who spends 15 h per week training. On examination, her vitals signs are normal, without orthostatic hypotension, and her neurological evaluation is unremarkable. Medical investigations including glucose, electrolytes, a urine toxin screen and an EEG are all within normal limits. As the spells continued, her parents tried vitamin supplements, homeopathic products and chiropractic sessions, without improvement. She was seen in consultation by a paediatrician who ordered a sleep-deprived EEG and an ECG, both of which were normal. Upon further questioning, she denies being stressed out, although she has an upcoming audition for Team Canada. There is a family history of anxiety disorders, and one of her best friends has a seizure disorder. She was referred to a psychologist. One week following her first psychological evaluation, she had a much more intense spell just after finishing her routine at a gymnastic competition. She warned of an impending seizure, sat down on the bench and put her head down just before losing consciousness. She was brought by ambulance to the emergency department, evaluated by the emergentologist and the attending neurologist who excluded organic causes. She was admitted under the care of a child psychiatrist. An event was captured by video EEG and interpreted as a pseudoseizure. A serum prolactin level drawn within 30 min of the ‘seizure’ was within normal limits. The final diagnosis was a conversion disorder (CD).