A review of the literature data and clinical observations indicates the pathogenetic role of oxidative stress (OS) in epilepsy. Oxidative stress is accompanied by increased generation of active forms of oxygen, oxidative destruction of lipids, proteins, nucleic acids, carbohydrates, leading to disruption of the structure and functional activity of the cells. The intensification of free radical oxidation in epilepsy is caused by a decrease in the activity of the brain system of antioxidant protection, as enzymatic so non-enzymatic level that determines the progression of pathological process.

Establishing misdiagnosis “epilepsy” is a common event comprising 25% total cases of “pharmacoresistant” forms. Eventually, the majority of cases resulted in diagnosing psychogenic nonepileptic seizures, or functional seizures, conversion seizures, and dissociative seizures. Here we review publications assessing psychogenic non-epileptic seizures. The scientific resources for analysis were selected in Russian (eLibrary) and international (Pubmed/MEDLINE, Google Scholar) databases, as well as in open access resources. We also present a clinical case of a patient diagnosed with epilepsy. In particular, the patient was admitted to the hospital with complains of paroxysmal conditions starting as headache, nausea proceeding with speech arrest and decreased mindfulness of what happens in personal life. He also informed about at least two episodes of disorientation described as “missed public transport stop” and “finding himself in unfamiliar place”. The patient underwent examination (electroencephalography, brain magnetic resonance imaging) and dynamic follow-up to verify origin of such conditions. As a result, he was diagnosed with psychogenic non-epileptic seizures. Administering proper therapy allowed to achieve stabilized condition and arrest seizures. The criteria provided in the review as well as clinical case report may help clinical practitioners to timely conduct differential diagnostics and deliver specialized medical aid.

Epilepsy affects millions of people around the world. Stimulation of the left vagus nerve (VNS) has proven to be effective in reducing the frequency of seizures for over 30 years, and some authors have noted the positive dynamics of the effect of stimulation on the emotional status of patients. In this clinical observation, we describe changes in the pathopsychological condition before and after VNS therapy in a patient with a drug-resistant form of epilepsy and suicidal intentions.

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