[Munchausen syndrome by proxy: report of one case with epilepsy].
BACKGROUND
Munchausen syndrome by proxy (MSBP) is a rare form of child abuse in which a parent, usually the mother, fabricates or produces illness in a child, so causing them unnecessary medical investigations, treatments and hospitalizations. One of the commonest false presenting symptom is 'seizures'.


METHODS
An eight years old boy with Munchausen syndrome by proxy is reported. This child had had genuine seizures well controlled by standard anticonvulsant treatment at the start of the false illness. At the age of seven years, the patient showed very frequent seizures. The child was treated with antiepileptic drugs, but treatments were ineffective and seizures continued. Results of multiple tests, including an extensive blood chemistry analyses, CT, MRI, SPECT, were normal. Electroencephalogram showed posterior slow waves. Acute neurological deterioration was observed six weeks after hospitalization and it was finally proved that seizures were caused or triggered by clomipramine poisoning given by her mother.


CONCLUSIONS
MSBP frequently presents as epileptic seizures in these abused children. MSBP diagnosis is more difficult to be made if true seizures exists with multiple fictitious seizures. Pediatrician should be alerted to the possibility of MSBP when seizures are poorly controlled, treatments are ineffective and there is no neurophysiologic dysfunction. Early diagnosis and intervention are essential because high mortality and psychologic morbidity are associated with this syndrome.
Fernández-Jaén
A
A
Servicio de Neurologia Pediátrica, Hospital Universitario La Paz, Madrid, España.
Martínez-Bermejo
A
A
López-Martín
V
V
Pascual-Castroviejo
I
I
D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects; D002648:Child; D002649:Child Abuse / Q000523:psychology; D002997:Clomipramine / Q000009:adverse effects; D004827:Epilepsy / Q000150:complications* / Q000209:etiology; D006801:Humans; D008297:Male; D008425:Maternal Behavior / Q000523:psychology; D016735:Munchausen Syndrome by Proxy / Q000150:complications* / Q000175:diagnosis*
D000929:Antidepressive Agents, Tricyclic; D002997:Clomipramine
Síndrome de Munchausen por poderes: presentación de un caso con epilepsia.