Doc, could the patient be "possessed"?

A patient of mine with past history of epilepsy presented with sudden change in behaviour recently.

She went for a trip to a holiday beach resort with her friends, and started to develop strange behaviour a few days later. She first complained of her right hand being "jammed" and was unable to play piano, then developed difficulties in expressive herself coherently, and started to have panic spells with insomnia/pacing in-out of the room ... these culminated eventually to spells with arching of the trunk backwards when she lay supine on the bed (making a reverse C-shaped), with head and legs pressed against the bed. Her mouth would be wide opened, neck flexed backwards, tongue rolled back, struggling hard to shout but no sounds appeared. She might thrash her legs involuntarily in the midst of the attacks at time. These episodes occurred intermittently, several times per day, lasting 5-20 minutes each. They persisted despite the use of high dose of sedative medicines. At times, at the end of the spells, she would uttered "help me" in exhausted voice. These paroxysmal spells were rather reminiscent of scenes from "The Exorcist". It was no surprise to me when some of the nurses surreptitiously asked me "Doc, could she be "possessed"?".

Traditional cultural / spiritual beliefs are very strong among residents of South East Asia. Many of us , particularly those staying in rural areas, grew up in society where folk tales about black magics, pontianak, spirits abound. Even those who stay in urban areas are not spared from the horror movies depicting evil spirits with Eastern flavour. When faced with things beyond reasonable scientific / logical explanations, people will resort to traditional spiritual realms for answers.

And back to my patient, I don't think she is "possessed". There is a neurological basis for the bizarre contorted postures she adopted. They are typical manifestation of frontal lobe seizures - with arching of trunk, thrashing of limbs and unresponsiveness. To the untrained eyes, these are too bizarre to be pure disturbance of brain activities. It is a real challenge to sort out the underlying cause of her seizures. Various tests to date (MRI, spinal tap, blood tests) have yielded negative results. A brain biopsy has just been performed (her family members finally consented) to help in identifying the exact diagnosis, so that the appropriate treatment and hopefully cure can be administered. My strong suspicion is she most likely has some form of inflammation of blood vessels of her brain (so called CNS vasculitis). The biopsy results should be available in a few days' time ... lets wait and see!

It is not easy to deal with the mental challenge of having to come out with various options to treat the ongoing seizures, let alone explaining to the family members the futility of our efforts to date. Kudos to the family members for being patient and understanding to me to date.