1
|
Welborn BL, Zwain BB. Severe Post-partum Hypothyroidism Triggering Psychogenic Non-epileptiform Seizures, Myopathy, and Myxedema Coma. Cureus 2024; 16:e61318. [PMID: 38813074 PMCID: PMC11135830 DOI: 10.7759/cureus.61318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/29/2024] [Indexed: 05/31/2024] Open
Abstract
This study details the development of severe post-partum hypothyroidism exacerbating psychogenic non-epileptiform seizures (PNES) and culminating in myxedema coma. A 29-year-old female with a history of anxiety, attention-deficit/hyperactivity disorder (ADHD), and post-partum depression presented with confusion, aphasia, and severe bilateral leg cramping five months following vaginal delivery. Initial laboratory tests indicated elevated creatine kinase (CK) levels, suggestive of non-traumatic rhabdomyolysis. Subsequent seizure-like episodes and the absence of epileptiform activity on the electroencephalogram (EEG) raised suspicions of PNES. Further investigation upon readmittance to the hospital revealed a thyroid-stimulating hormone (TSH) level of 216 mIU/L (range: 0.4-4.0 mIU/L), free thyroxine (T4) level of 0.2 ng/dL (range: 0.8-1.8 ng/dL), and a CK level of 2083 U/L (range in females: 30-150 U/L), indicating severe hypothyroidism with myopathy. Reintroducing levothyroxine (Synthroid), which was previously discontinued during pregnancy, rapidly resolved her symptoms, supporting suspicions that her non-epileptic seizures and myopathy were both caused by her underlying severe post-partum hypothyroidism. She was maintained on levothyroxine with only one seizure-like episode following hospital discharge. This case illustrates the importance of a thorough endocrine assessment in patients with neuropsychiatric presentations, particularly in the peripartum period. It highlights the potential for severe thyroid dysfunction to manifest as PNES, emphasizing the complexity of diagnosing and managing such cases. The findings advocate for a multidisciplinary approach to evaluating post-partum females with neurological and psychiatric symptoms and provide evidence for the link between thyroid disorders and PNES, advocating for a nuanced approach in similar clinical scenarios.
Collapse
Affiliation(s)
- Brandon L Welborn
- Neurology, Edward Via College of Osteopathic Medicine, Spartanburg, USA
| | - Benjamin B Zwain
- Neurology, Bon Secours St. Francis Health System, Greenville, USA
| |
Collapse
|
2
|
Coogle J, Coogle B, Quezada J. Hypnosis in the Treatment of Pediatric Functional Neurological Disorder: The Magic Glove Technique. Pediatr Neurol 2021; 125:20-25. [PMID: 34624606 DOI: 10.1016/j.pediatrneurol.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
The treatment of functional neurological disorder (FND), previously referred to as conversion disorder, can be challenging. Despite these challenges and with increased understanding of this condition, new treatment options are emerging. One such treatment is hypnosis, which has a long history of use in the treatment of FND. Jean-Martin Charcot, considered by many to be the father of modern neurology, used therapeutic hypnosis as early as the 19th century. In this report, we discuss the novel use of a hypno-anesthetic technique (the magic glove) for treatment of FND presenting as diplegia. We illustrate the use of the technique with the case of a 9-year-old girl who suffered from chronic pain and lower extremity weakness secondary to FND. With the magic glove technique, she improved rapidly and was free of symptoms by her sixth month follow-up visit. We review the current literature on FND interventions and emphasize the need for continued research in this field.
Collapse
Affiliation(s)
- Justin Coogle
- Child Neurology Resident at Children's Mercy, Kansas City, Missouri.
| | - Brianna Coogle
- Internal Medicine Resident at The University of Kansas Health System and The University of Kansas School of Medicine, Kansas City, Kansas
| | - Julio Quezada
- Division of Neurology, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, Missouri
| |
Collapse
|
3
|
Vanek J, Prasko J, Ociskova M, Genzor S, Holubova M, Hodny F, Nesnidal V, Slepecky M, Sova M, Minarikova K. Sleep Disturbances in Patients with Nonepileptic Seizures. Nat Sci Sleep 2021; 13:209-218. [PMID: 33623462 PMCID: PMC7896787 DOI: 10.2147/nss.s289190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Up to 20% of patients treated for epileptic seizures experience psychogenic nonepileptic paroxysms (PNES). These patients present a significant burden for the health care systems because of poor treatment outcomes. The presented review aims to summarize the current state of knowledge on sleep disturbances in patients with nonepileptic seizures. METHODS Articles were acquired via PubMed and Web of Science, and papers between January 1990 and March 2020 were extracted. Inclusion criteria were (1) published in a peer-reviewed journal: (2) studies in humans only; or (3) reviews on a related topic; (4) English language. The exclusion criteria were: (1) abstracts from conferences; (2) commentaries; (3) subjects younger than 18 years. From primary assessment, 122 articles were extracted; after obtaining full texts and secondary articles from reference lists, 45 papers were used in this review. RESULTS Limited data are available regarding sleep disorders in PNES patients, over the last 30 years only nine original research papers addressed sleep problems in patients with PNES with only six studies assessing objectively measured changes in sleep. Current literature supports the subjective perception of the sleep disturbances with mixed results in objective pathophysiological findings. Conflicting results regarding the REM phase can be found, and studies reported both shortening and prolonging of the REM phase with methodological limitations. Poor sleep quality and shortened duration have been consistently described in most of the studies. CONCLUSION Further research on a broader spectrum of patients with PNES is needed, primarily focusing on objective neurophysiological findings. Quality of life in patients suffering from PNES can be increased by good sleep habits and treatment of comorbid sleep disorders.
Collapse
Affiliation(s)
- Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Samuel Genzor
- Department of Respiratory Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Vlastmil Nesnidal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Milan Sova
- Department of Respiratory Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, The Czech Republic
| | - Kamila Minarikova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| |
Collapse
|