PSYCHOGENIC NON-EPILEPTIC SEIZURE – IS IT VITAMIN B12 BEHIND

Clinicians often are confronted with symptoms or signs that may be inappropriate to a particular disease. This often keeps them in diagnostic dilemma leading to administration of certain medications which may not be needed. Our patient was a 16-year-old male with complaints of chest tightness and involuntary limb movements.There was no similar episode in past medical history. He did not have known chronic illness or substance abuse. His current manifestations mimicked a seizure with tonic-clonic nature of the limb movements.His biochemistry revealed hypocalcaemia and B12 deficiency. Careful watching of his activities, important investigations especially video electroencephalogram (EEG)and neuropsychiatric opinion confirmed the diagnosis to be a psychogenic nonepileptic seizure with hyperventilation syndrome. He was initially on antiepileptic drug (AED) but after diagnostic confirmation only B12 correction and psychiatric counselling made him recover well.This case highlights the importance of in-depth history taking with keen observation of the clinical manifestations.