1337 - Multimodal Rehabilitation Approach to Young Adult Patient with Psychogenic Non-Epileptic Seizures

A 24 year old female with history of migraines and childhood anxiety, depression, and post-traumatic stress disorder presents with worsening non-rhythmic jerking and hemiballismus-like movements of the bilateral back and extremities triggered by pain and anxiety. Recently, the patient reported an increase in frequency of seizure-like episodes and a >16% unintentional weight loss in 6 months due to decreased PO intake. A 24-hour video EEG showed no abnormalities. On exam, the patient continued to exhibit variable non-rhythmic movements not characterized by hallmark epileptogenic seizures. A multimodal treatment approach consisting of pharmacological (SSRIs, muscle relaxants, analgesics), psychological, and physical rehabilitation was initiated. Along with functional improvement in ambulation, activities of daily living, and cognition, the patient was observed to have markedly decreased frequency and severity of non-rhythmic jerking as well as reported improvement in mood and irritability.

Discussions: Management of PNES is a formidable rehabilitation challenge. Physiatrists must acknowledge and empathize with the patient’s condition and functional impairment to promote adaptive behaviors while also minimizing maladaptive responses. This case reinforces the efficacy of a multidisciplinary regimen for the rehabilitation of functional neurological disorders (FND) such as PNES.

Conclusions: Patients with PNES and FND experience extremely debilitating symptoms, often worsened by the lack of acknowledgement of their experiences. While treatment of PNES remains challenging for most medical providers, the crucial components of acknowledgement and multimodal therapy will aid patient recovery and improve their quality of life.