PSYCHOGENIC NON-EPILEPTIC SEIZURES IN A CHILD: A CASE REPORT

Abstract

Background: Psychogenic non-epileptic seizures (PNES) in children present a diagnostic and therapeutic challenge, particularly in settings where neurological and psychiatric resources are limited. These episodes often mimic epileptic seizures but lack corresponding EEG abnormalities and are rooted in psychological distress. Early identification and intervention are critical to prevent misdiagnosis, unnecessary pharmacologic treatment, and long-term functional impairment. This case highlights the clinical value of a multidisciplinary, culturally sensitive approach in managing PNES in a child following trauma and chronic stress.

Case Presentation: An 11-year-old boy from Pakistan presented with frequent seizure-like episodes triggered by a traumatic robbery and intensified by academic stress. Despite multiple daily events, neurological investigations including EEG were unremarkable. Psychological evaluation revealed moderate post-traumatic stress and clinically significant anxiety symptoms, as measured by the PTSD Checklist for Children (score: 30) and the RCADS Anxiety Subscale (score: 28). Additional assessment and family mapping revealed complex psychosocial stressors, including unresolved grief, a history of infertility, and familial overprotection.

Intervention and Outcome: The patient underwent a structured 12-week intervention comprising psychoeducation, trauma-focused cognitive-behavioral therapy (TF-CBT), mindfulness and grounding techniques, seizure diary tracking, and family therapy. Each component was tailored to his developmental level and cultural context. By the end of treatment, seizure frequency had decreased by 80%, anxiety and PTSD symptoms had subsided to subclinical levels, and school attendance and daily functioning markedly improved.

Conclusion: This case underscores the effectiveness of a biopsychosocial model in managing pediatric PNES. Early, tailored psychological intervention with active family engagement can significantly improve outcomes in children experiencing trauma-related functional symptoms. Further research is warranted to explore long-term outcomes and scalability in similar contexts.