Non-epileptic events and functional seizures — structured clinical encounter

A fifteen-year-old girl is referred to your general paediatric clinic for spells that began a year ago and now occur several times a week. Each attack lasts five to ten minutes: she slumps, her eyes are closed and she resists them being opened, her limbs move in a variable thrashing pattern that waxes and wanes, she groans occasionally, and within a minute of the event ending she is tearful but fully oriented with no confusion or drowsiness. She has been started on two escalating antiseizure medications over the year without any change in the frequency or pattern of the events. Her parents separated six months ago, her mother has a history of depression, and she has missed substantial schooling. She has no history of epileptic seizures. On examination she is back to baseline, with a normal neurological examination, no neurocutaneous stigmata, and a positive Hoover sign when functional weakness is suggested.