Pseudoseizures
Pseudoseizures or nonepileptic seizures are not caused by abnormal electrical activities in the brain. Experts believe that these seizures are physical reactions to mental or psychological stress.
Overview
A seizure is a sudden event caused by an uncontrolled electrical disturbance in the brain. When a seizure happens, you lose control of your body, possibly lose consciousness, and convulse. Seizures can also cause behavioral changes and changes in the levels of your consciousness, including changes in your feelings or movements.
Epilepsy is a brain disorder, which is caused by sudden abnormal electrical discharges or misfiring of neurons in the brain. However, there are also seizures that are not accompanied by abnormal electrical discharges, such as non-epileptic seizures.
Non-epileptic seizures are formerly called pseudoseizures. These seizures are characterized by falling and shaking, which are features that are somewhat similar to generalized convulsions or grand mal epileptic seizures. Although nonepileptic seizures tend to resemble epileptic seizures, their cause is very different.
The Latin word pseudo in pseudoseizures means false, which can mislead people. It is important to note than nonepileptic seizures are quite real and can cause loss of total control and consciousness. Experts believe that these seizures are physical reactions to mental or psychological stress. Sometimes, they are also called psychogenic nonepileptic seizures (PNES).
Pseudoseizures or nonepileptic seizures are fairly common. Around 20-30 percent of people who are referred to epilepsy centers are diagnosed with nonepileptic seizures, according to the Epilepsy Foundation. Although these type of seizures can occur at any age, most of the patients affected are between the ages of 20-40. Women are also three times more likely to have nonepileptic seizures than men.
Symptoms of Pseudoseizures
The symptoms of pseudoseizures tend to be similar to that of epileptic seizures, which include:
- Staring
- Loss of attention
- Falling
- Stiffening of the body
- Convulsions
- Rhythmical jerking movements
Other mental health conditions may also be present in some people who experience pseudoseizures.
Causes of Pseudoseizures
Pseudoseizures are often stress-induced unlike epileptic seizures, which are a result of physical brain disease. People with traumatic psychological experiences can produce physical reactions even without physical illnesses.
It is also well known that some extreme psychological and emotional stresses can actually cause physical illnesses. These illnesses are regarded as psychosomatic (mind-body) illnesses, such as headaches, chest pain, and asthma. Other conditions that are often associated with nonepileptic seizures and are believed to be stress-induced include fibromyalgia, irritable bowel syndrome, and other pain syndromes.
Somatic symptom disorder (SSD), formerly called somatoform disorder, is a form of mental illness that causes symptoms due to emotional stresses. These symptoms tend to resemble the symptoms of physical illnesses, such as pain. The most common type of SSD is conversion disorder. There is also a specific category called conversion disorder with seizures, where pseudoseizures fall into, as stated in the official psychiatric classification (DSM-IV).
Since pseudoseizures are usually a result of psychological distress, they can have a number of possible causes, which include:
- Physical abuse
- Sexual abuse
- Incest
- Substance abuse
- Family conflict
- Divorce
- Death of a loved one
- Head trauma
- Anger management issues
- Anxiety
- Panic attacks
- Psychosis
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Attention deficit hyperactivity disorder (ADHD)
- Borderline personality disorder
- Dissociative disorders
- Affective disorders
Diagnosis
An accurate diagnosis is very important, so patients will receive the appropriate treatment. People with nonepileptic seizures are often misdiagnosed with epilepsy because most of the time, doctors are not there to witness the event. To accurately diagnose pseudoseizures, both neurologists and psychiatrists have to work together.
The diagnosis of nonepileptic seizures usually requires EEG-video monitoring with expert EEG interpretation. This diagnostic procedure may require several hours to days of patient monitoring using a video camera and an EEG until a seizure happens.
In some cases, inductions, activation procedures, or provocative techniques are used, especially when there are no spontaneous episodes that occur during the monitoring, and when the diagnosis is uncertain. In fact, there are many epilepsy centers that use provocative techniques to help in the diagnosis of nonepileptic seizures. Other techniques may be preferable, but the most commonly and traditionally used is an intravenous injection of saline.
A near 100-percent certainty in the diagnosis of nonepileptic seizures can be made by specialists after analyzing the video and EEG recordings. Patients are often referred to a psychiatrist upon diagnosis to help identify if there are psychological reasons, which could be causing the nonepileptic seizures.
Additionally, it is also possible for patients to be diagnosed with both epilepsy and pseudoseizures.
Treatment
According to studies, it is still unclear whether medications for epilepsy can help treat nonepileptic seizures. However, experts consider medications for mood disorders as a viable treatment plan.
Another significant part of treatment is determining the root cause of the disorder. Effective treatment methods for nonepileptic seizures may include:
- Cognitive behavioral therapy
- Behavioral or relaxation therapy
- Family counseling
- Individual counseling (psychotherapy or talk therapy)
- Eye movement desensitization and reprocessing (EMDR) therapy
Patients can be treated as an outpatient or at an inpatient facility. Counseling or therapy can be conducted by social workers, psychologists, and psychiatrists.
Antiseizure medications tend to be ineffective when it comes to treating nonepileptic seizures. For this reason, most patients are referred to therapists or psychiatrists to become familiar with coping techniques and to learn how to handle stressful situations. Behavioral modification therapy can be one of the effective treatments for nonepileptic seizures.
Outlook
The overall outlook is good and with proper treatment, pseudoseizures may eventually disappear in 60-70 percent of adults. The percentages also tend to be higher in children and adolescents. However, it is important to note that psychiatric treatments take time and are not a quick fix.
Not following up with the treatment and refusing diagnosis are some of the common mistakes that most patients commit. Patients who are inclined to make these choices tend to continue taking antiepileptic drugs, which are likely ineffective for their condition.
Having an early diagnosis is also an important factor. If a wrong diagnosis of epilepsy is early caught, a patient has a better chance of full recovery. Antiepileptic medications should also be tapered off and not suddenly stopped. Always follow your neurologist’s instructions when stopping medications.
References
Nonepileptic Seizures or Events. (January 2013). https://www.epilepsy.com/learn/types-seizures/nonepileptic-seizures-or-events
Benbadis, SR and Heriaud, L. Psychogenic (Non-Epileptic) Seizures, A Guide for Families & Patients. http://hsc.usf.edu/COM/epilepsy/PNESbrochure.pdf
The Truth about Psychogenic Nonepileptic Seizures. (November 2007). https://www.epilepsy.com/article/2014/3/truth-about-psychogenic-nonepileptic-seizures
Lesser, R. Treatment and Outcome of Psychogenic Nonepileptic Seizures. Epilepsy Curr. (2003)
