hardtemporal-lobe-epilepsygeschwind-syndromeautomatismsfocal-seizurespsychiatric-mimics
A 29-year-old male is referred for psychiatric evaluation after being diagnosed with dissociative disorder by a previous provider. He reports episodes occurring 2-3 times per month over the past 2 years, beginning with an intense feeling of deja vu and a rising epigastric sensation, followed by 60-90 seconds of staring with unresponsiveness and bilateral hand-wringing automatisms, for which he has no memory afterward. Between episodes, he reports increased religiosity, hypergraphia (keeping extensive detailed journals), and a tendency to become preoccupied with philosophical and existential topics. His wife reports that during one episode, she observed lip smacking and repetitive swallowing movements followed by a period of confusion lasting 5-10 minutes. A routine EEG is normal, but a 72-hour ambulatory EEG captures an event with left temporal spike-and-wave discharges during a typical episode. Which of the following is the most likely diagnosis?