title: Nonconvulsive status epilepticus precipitated by carbamazepine presenting as dissociative and affective disorders in adolescents.
abstract: Nonconvulsive status epilepticus can be confused with psychiatric disorders. Inappropriate drug treatment can represent a precipitating factor. We describe two patients with idiopathic generalized epilepsy in whom nonconvulsive status epilepticus, aggravated by carbamazepine, was misdiagnosed as psychiatric disorder. A 14-year-old girl experienced a tonic-clonic seizure at age 12 years preceded by monthly episodes of confusion with awkward behavior since age 9 years. She was treated with carbamazepine, and the episodes of confusion became more frequent, leading to a diagnosis of dissociative disorder. An electroencephalogram during one of these episodes revealed nonconvulsive status epilepticus. Substitution of carbamazepine with valproic acid controlled the episodes of status epilepticus. A 23-year-old woman presented at age 16 years with a tonic-clonic seizure. Since early adolescence, she had had episodes of depressive mood, worsening of school performances, and facial tics. Carbamazepine treatment caused worsening of the depressive episodes and facial tics. An electroencephalogram during a typical episode revealed nonconvulsive status epilepticus. Carbamazepine substitution with valproate led to seizure freedom and behavioral improvement. Nonconvulsive status epilepticus should be suspected and searched for in patients with epileptic seizures and ictal or fluctuating behavioral disorders.
authors.affiliation: Epilepsy, Neurophysiology and Neurogenetics Unit, IRCCS Stella Maris Foundation, Pisa, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Marini
authors.forename: Lucio
authors.initials: L
authors.lastname: Parmeggiani
authors.forename: Gabriele
authors.initials: G
authors.lastname: Masi
authors.forename: Gianluca
authors.initials: G
authors.lastname: D'Arcangelo
authors.forename: Renzo
authors.initials: R
authors.lastname: Guerrini
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D002220:Carbamazepine / Q000009:adverse effects* / Q000627:therapeutic use; D003866:Depressive Disorder / Q000139:chemically induced* / Q000175:diagnosis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004213:Dissociative Disorders / Q000139:chemically induced* / Q000175:diagnosis; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D006801:Humans; D013226:Status Epilepticus / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D000927:Anticonvulsants; D002220:Carbamazepine