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Questions/Diagnosis & Assessment/Q238 of 246
hardPNESpseudoseizuresconversion disorderfunctional neurological disordervideo-EEGtrauma
A 28-year-old woman is referred for psychiatric evaluation after video-EEG monitoring during a 3-day admission revealed no epileptiform activity during four observed clinical events that had previously been diagnosed as seizures. During the monitored events, she exhibited bilateral asynchronous limb movements with side-to-side head shaking, pelvic thrusting, eye closure with resistance to passive eye opening, and episodes lasting 3 to 7 minutes. She remained responsive to verbal commands during two of the four events, though she reported amnesia for the episodes afterward. Her neurologist noted preserved pupillary reflexes, absence of postictal confusion proportional to event duration, and no tongue biting or incontinence. She has a history of childhood sexual abuse and was diagnosed with PTSD at age 19. She has been taking two antiepileptic medications for the past 4 years with no seizure reduction. Her neurological examination between events is completely normal. Which of the following assessment findings is most consistent with this presentation?
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