[P1-68] Patients with psychogenic non-epileptic seizure (PNES), secondary to refractory epilepsy in Japanese regional emergency center
We report two cases that PNES arose secondarily from refractory epilepsy, and had difficulty in controlling PNES. Although each case decreased their PNES by environmental coordination, and has still both kind of attacks. It is confusing to choose treatments for PNES cases with epileptic comorbidity, because of difficulty in instant diagnosis without support of child neurologists, psychologists and child psychiatrists. However no emergency center has permanent child psychiatrists in our region, and no emergency patient is taken in by hospitals with them. To accept these cases safely and totally, we need innovation from current emergency medical system. [Case 1] she had atypical absence and general tonic-clonic seizures (GTCs) at age 1. EEG indicated general spike-and-waves during ictus and bilateral temporal to parietal spike-and-waves during inter ictus. VPA, TPM and NZP were not effective. ESM, CLB and LTG were partially effective. Intellectual impairment became apparent after her admission to primary school. She had frequently blink attacks and consciousness disturbance at age 7, and visited ER from her school. Ictal EEG showed only interictal pattern. [Case 2] She had sudden standstills and GTCs at age 9. EEG indicated sharp waves in right frontal to centrotemporal areas during inter ictus. CBZ and ZNS were not effective. CLB stopped the attacks. She had loss of consciousness and GTCs at age 14. Those seizures happened often before the start to her school in the morning and very few in summer and winter holidays. Video-EEG showed no epileptic discharges in the morning.