Neuropsychiatric practice provides for the interested practitioner a bewildering yet exciting array of symptoms and syndromes. Some are quite common, such as a psychosis is in epilepsy, but many are rare, and sometimes the rarer they are, the more startling and challenging they seem. Take the Moebius syndrome. This is an unusual condition in which there is a congenital palsy of some cranial nerves—most notably the 6th and 7th—usually with hypoplasia or agenesis of the respective nerve nuclei. For example, the patient I was asked to see, because of unremitting seizures, was a girl in her late teens, who had never had any facial expression. She could not smile or express laughter, she could not look angry, she could not contort her face to tears or grief. But did she feel emotions? Of course. She got angry like the rest of us, teared when sad, and was able laugh. The vocalizations of her affects were all present, she simply could not show emotions.
Not surprisingly, this had affected her social development, and inhibited her interactions with her peers. She was frustrated by this inhibition and, in the course of her adolescence, had developed depression and panic attacks, which had been mistakenly diagnosed as epilepsy. This is one variant of the pseudoseizure spectrum.