Abstract Details

Title Psychogenic Non-epileptic Seizures Secondary to Forced Normalization Phenomenon in a Patient with Eyelid Myoclonia with Absence Epilepsy (Jeavons Syndrome): A Case Report

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 10-009

Objective To describe the first reported case of psychogenic non-epileptic seizures (PNES) as a manifestation of forced normalization (FN) in a patient with drug-resistant Epileptic Eyelid Myoclonia (EEM), highlighting diagnostic and therapeutic challenges.

Background Epilepsy with eyelid myoclonia (EEM) is a rare subtype of genetic generalized epilepsy characterized by eye-closure–induced seizures, photosensitivity, and EEG paroxysms, typically beginning in childhood with a female predominance. Forced normalization (FN) refers to the emergence of psychiatric symptoms following seizure control. Psychosis is most common, but other manifestations, including PNES, may occur.

Design/Methods A 26-year-old female with long-standing, drug-resistant EEM began experiencing eyelid myoclonia and absence seizures at age 10, refractory to multiple antiseizure medications (oxcarbazepine, valproate, lamotrigine, lacosamide). At age 24, ethosuximide was introduced to target absence seizures. Eleven days later, she developed brief, fluctuating episodes characterized by asynchronous limb movements, forced eyelid closure, and upward gaze deviation, without postictal confusion. Video-EEG captured these events without electrographic correlates. Psychiatric evaluation diagnosed PNES and mixed anxiety-depressive disorder. Ethosuximide was discontinued, while levetiracetam and clobazam were maintained.

Results

The patient met Krishnamoorthy and Trimble’s FN criteria, including ≥50% reduction in interictal spike frequency compared to baseline EEG. She achieved seizure freedom before PNES onset and has remained seizure-free for two years, though PNES persists 1–2 times per week despite psychiatric treatment.

Conclusions

This is the first reported case of PNES as a manifestation of FN in EEM, representing the close interaction between epilepsy control and emergent psychiatric symptoms. Ethosuximide may act as a pharmacological trigger in susceptible patients. Early recognition of FN is crucial for preventing misdiagnosis and optimizing interdisciplinary management strategies.

Authors/Disclosures
Fernando Vasquez Lopez, MD PRESENTER	Dr. Vasquez Lopez has nothing to disclose.
Juan C. Vera, Jr., Medical Student	Dr. Vera has nothing to disclose.
Maximiliano D. Salgado Deza	Maximiliano D. Salgado Deza has nothing to disclose.
Salvador Martinez-Medina, MD	Dr. Martinez-Medina has nothing to disclose.
Jimena Gonzalez Salido, MD	Miss Gonzalez Salido has nothing to disclose.
Jimena Colado, MD	Dr. Colado has nothing to disclose.
Stefan Narvaez-Labuhn, Medical Student	Mr. Narvaez-Labuhn has nothing to disclose.
Mariana Peschard Franco (Medica Sur)	Mrs. Peschard Franco has nothing to disclose.
Andres Felipe Morcillo Muñoz, Sr., MD	Dr. Morcillo Muñoz has nothing to disclose.
Katherin M. Plasencia Correa, MD	Dr. Plasencia Correa has nothing to disclose.
Iris E. Martinez-Juarez, MD (Instituto Nacional de Neurología y Neurocirugía)	No disclosure on file

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