Post-Lightning-Strike Psychogenic Non-Epileptic Seizure: A Case Report

Abstract

Psychogenic Non-Epileptic Seizures (PNES) are paroxysmal spells which bear a semblance to an epileptic seizure. Neurobehavioral complications following lightning strikes are frequent and resemble the symptoms of patients with traumatic brain injury. We describe the case of a 9-year-old boy who was struck by lightning while playing by the door of his classroom during a thunderstorm. He fell and was unconscious for about 20 minutes, after which he woke up with no significant injuries. The immediate effect of the attack on the patient's organs was not identified, as he was not taken to a health facility for review immediately after the attack. However, four days later, he developed persistent myoclonic jerks of several episodes per day, with varying durations and intervals, which could be induced by touch, noise and light. It is sometimes associated with loss of consciousness. Physical examination of the patient did not reveal any neurologic deficit. A 24-hour Long-Term Video Electroencephalogram Monitoring (LTVEM) done showed a normal study with photic-induced non-epileptic generalised myoclonus. Therefore, the diagnosis of trauma-induced stimulus-sensitive Psychogenic Myoclonus, a type of PNES, was entertained. The child responded to oral Clonazepam and Levetiracetam and was sent for physiotherapy and child psychology review before he was lost to follow-up. In conclusion, exposure to lightning injuries requires a holistic approach to their management, and the resultant seizures may not always be of cranial origin.