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Focal Seizures and Borderline Personality Disorder Associated with Protein S Deficiency and Multiple White Matter Ischemic Lesions

Author(s): Tomohiko Murai, Kwiyoung Park, Kaoru Obata, Masako Kinoshita

Neurological symptoms of patients with protein S deficiency remain elusive. We report a female case with protein S deficiency who started having episodes of sudden nausea, white out of the whole visual field, loss of consciousness, and falling down with convulsion at the age of 18. She was co-morbid with borderline personality disorder and gender identity disorder, and was treated with psychotherapy. She was suffering from extreme emotional lability causing deterioration of interpersonal relationships and repeated episodes of a suicidal attempt. Long-term video EEG revealed that her seizures started with abrupt visual symptoms followed by fine convulsion of extremities. Interictal EEG showed intermittent rhythmic slow waves and repetitive epileptiform discharges at bilateral parietal and occipital areas, and these activities became more frequent during ictal state. Brain MRI showed multiple spotty T2 and FLAIR high intensity lesions in deep white matter and subcortical areas disproportionate to her age. In blood test, the quantity of protein S was decreased to 53% (normal range; 65%-135%). The data of this patient suggest relationship among focal seizures, psychological complications, coagulation disorders, and brain ischemic lesion, which should be further investigated.

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