Minimising harm: avoiding intubation for psychogenic non-epileptic seizures

A 25-year-old man presented to the emergency department of a tertiary hospital following a seizure. His past medical history included epilepsy, for which he was taking levetiracetam 1000 mg and valproate 1000 mg, each twice daily.

While the patient was in the department, an emergency code was activated by nursing staff. On review, he was unresponsive, with waxing and waning bilateral upper and lower limb low amplitude movements. During these movements, his eyes were closed and intermittent eyelid fluttering was present. The movements continued beyond five minutes, and the treating medical officer considered whether there was a role for benzodiazepines, antiseizure medications, or intubation. A safe, calm environment was maintained, and no additional medications were administered. The movements ceased after ten minutes and the patient quickly returned to a normal level of responsiveness...