複数の発作周辺期精神症状を含む多彩な発作症状を呈した部分てんかんの1例

A Case of Focal Epilepsy Manifesting Multiple Psychiatric Auras

複数の発作周辺期精神症状を含む多彩な症状を呈した，部分てんかんの1例を報告する。症例は20歳女性。17歳から「意識が飛ぶ」感覚のほかに，既視感，恐怖感，憑依感などの多彩な自覚症状や，「暴れる」発作ならびに全身痙攣が出現した。これらの発作像は各々毎回一定していた。前医では精神疾患として加療されていたが改善はみられなかった。長時間ビデオ脳波モニタリングで，右半球に脳波変化を伴う過運動発作および二次性全般化発作が記録された。頭部MRIでは脳室周囲に結節性異所性灰白質が指摘された。部分てんかんの診断でカルバマゼピンを開始され発作はすべて消失した。本症例は複数の精神性前兆を呈する部分てんかんの診断にとって示唆に富む症例と考えられた。各々の発作症状がステレオタイプな場合，てんかんを鑑別に挙げることは重要である。

Abstract

We present a case of epilepsy with multiple types of focal seizures that were misdiagnosed as psychiatric disorders. A 20-year-old female patient presented with a variety of episodes, including loss of consciousness, deja vu, fear, delusion of possession, violent movements, and generalized convulsions. Each of these symptoms appeared in a stereotypic manner. She was initially diagnosed with a psychiatric disorder and treated with psychoactive medications, which had no effect. Long-term video electroencephalography revealed that her episodes of violent movement with impaired consciousness and secondarily generalized seizure were epileptic events originating in the right hemisphere. High-field brain magnetic resonance imaging for detecting subtle lesions revealed bilateral lesions from periventricular nodular heterotopia. Her final diagnosis was right hemispheric focal epilepsy. Carbamazepine administration was started, which successfully controlled all seizures.

The present case demonstrates the pitfall of diagnosing focal epilepsy when it presents with multiple types of psychiatric aura. Epilepsy should thus be included in differential diagnoses, considering the stereotypic nature of symptoms, to avoid misdiagnosis.

(Received March 5, 2014; Accepted June 30, 2014; Published January 1, 2015)