Epilepsy Talk

Epilepsy Versus “Pseudo-Seizures” | December 27, 2010


Epilepsy is not a dirty word.  Neither is pseudo-seizures.  But they both coexist, side by side.

One of the most common complications is the misconception that people who suffer from pseudo-seizures are hypochondriacs, hysterics, or “faking it.” The name for the condition alone, “pseudo-seizures,” perpetuates that misunderstanding.

The term “pseudo-seizures” is extremely misleading. The seizures are quite real, and people who have then do not have conscious, voluntary control over them. They are “false” only in that they have no physical cause; rather, they are said to be psychological or physical reactions to stresses. Although their causes are different, “pseudo-seizures” definitely resemble epileptic seizures and often it’s difficult to tell the difference.

They may be generalized convulsions (similar to “grand-mal” epileptic seizures) that are characterized by falling and shaking. Others are similar to the “petit mal” or “complex partial” epileptic seizures that are limited to temporary loss of attention, “staring into space,” or “dozing off.” And although you may not have known that seizures can have psychological causes, many people have such seizures.

In fact, at the Cleveland Clinic, they see between 50 and 100 patients each year who suffer from pseudo-seizures — usually one or two patients each week. About 75% of these patients are women, and most are between the ages of 20 and 40, although pseudo-seizures occur in both younger and older patients as well.

Often, the misdiagnosis of epilepsy is common. Even experienced epileptologists can mistake non-epileptic seizures for epileptic seizures and vice versa. Epileptic seizures of frontal lobe origin are unfortunately often mistaken for non-epileptic seizures. And according to research, approximately 25% of patients with a previous diagnosis of epilepsy are misdiagnosed.  EEGs misinterpreted as providing evidence for epilepsy often contribute to this misdiagnosis. And reversing a misdiagnosis of epilepsy can be difficult, as it is with other chronic conditions. Unfortunately, after the diagnosis of seizures is made, it is easily perpetuated without being questioned.

To make things a little more confusing, there are two classifications among these non-epileptic seizures: a physiologic or a psychogenic seizure.  And even between the two types of “pseudo-seizures,” there is a difference…

Psychogenic Non-Epileptic Seizures – (PNES)

The first type of non-epileptic seizures, as defined by the Epilepsy Foundation, is psychogenic non-epileptic seizures. They’re seizures caused by psychological trauma or conflict that impacts the patient’s state of mind. 

The Epilepsy Foundation states that sexual or physical abuse is the leading cause of psychogenic seizures, where the abuse occurred during childhood or more recently: life changes, like death and divorce are another possible cause of a psychogenic seizures.  This form of seizure often resembles a complex partial or tonic-clonic (grand-mal) seizure, with generalized convulsions, stiffening, jerking, falling, shaking and crying. Less often, a psychogenic seizure resembles a complex partial seizure, with a temporary loss of attention.

Interestingly, about 1 in 6 of these patients either already has epileptic seizures or has had them. So different treatment is needed for each disorder. Psychogenic non-epileptic seizures are most often seen in adolescents and young adults, but they also can occur in children and the elderly. And they are three times more common in females!

Doctors have identified certain kinds of movements and patterns that seem to be more common in psychogenic seizures than in seizures caused by epilepsy. Some of these patterns do occur occasionally in epileptic seizures however, so having one of them does not necessarily mean that the seizure was non-epileptic.

Video-EEG monitoring is the most effective way of diagnosing non-epileptic seizures. The doctor may take steps to provoke a seizure and then ask a family member or friend of the patient to confirm that the event was the same as the usual kind.

Although there is trauma involved, psychogenic non-epileptic seizures do not necessarily indicate that the person has a serious psychiatric disorder. But the problem does need to be addressed and many patients need treatment.

Sometimes the episodes stop when the person learns that they are psychological. Some people have depression or anxiety disorders that can be helped by medication. Counseling for a limited time is often helpful.  And the prognosis is good, with 60 to 70 percent of patients alleviated of seizure symptoms.

Another possible way of coping is to reduce your stress, take time out, go for a walk, try deep breathing (but NOT hyperventilating!) music, meditation, muscle relaxation or even biofeedback.

And above all…be kind to yourself.

Physiologic Non-Epileptic Seizures (NES)

A physiologic seizure is a temporary loss of control that is often accompanied by convulsions, unconsciousness, or both. Most common are seizures, which are caused by a sudden abnormal electrical discharge in the brain.

Sometimes, and for lots of different reasons, one or another of these electrical discharges may grow and spread abnormally to other parts of the brain, which in turn generates their own abnormal discharges. This has a cascading effect, and within a few seconds, the entire cerebral cortex can be discharging at once.

The resulting seizures most often imitate complex partial or tonic-clonic (grand mal) seizures. Full loss of consciousness, stiffening and jerking of all four limbs, plus a period of confusion often accompany the event. 

Examples of medical causes of physiologic seizures include hypoglycemia, hypoatremia, cardiac arrhythmia, brain lesions, syncopal episodes, migraines and transient ischemic attacks.  The National Institutes of Neurological Disorders and Stroke adds that narcolepsy and Tourette syndrome are other possible causes of physiologic seizures. Differentiating physiologic seizures and epileptic seizures can be difficult, so medical assessment and careful monitoring is needed.

Keeping a daily seizure diary can be helpful, noting how you feel before a seizure (triggers?), during a seizure (symptoms?), and after a seizure, including the duration of the event.  This can help both you and your doctor better understand what is going on with your body.  

Other articles of interest:

Trial examines treatment for psychogenic nonepileptic seizures http://www.sciencedaily.com/releases/2014/07/140702170034.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine%2Fepilepsy+%28Epilepsy+Research+News+–+ScienceDaily%29

Epileptic or non-epileptic seizures? Misdiagnosis common http://www.sciencedaily.com/releases/2014/04/140428171528.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine%2Fepilepsy+%28Epilepsy+Research+News+–+ScienceDaily%29

Study Of Non-Epileptic Seizures Has Surprising Results
http://www.medicalnewstoday.com/releases/253501.php

Diagnosis of Psychogenic Non-Epileptic Seizures http://professionals.epilepsy.com/page/newsletter_102313_pnes.html?utm_source=Epilepsy+Therapy+Project&utm_campaign=db5a6f1e09-Professionals_News_10_23_13&utm_medium=email&utm_term=0_cf0feb6500-db5a6f1e09-12023081

To subscribe to Epilepsytalk.com and get the latest articles by email, simply go to the bottom box of the right column and click on “Sign me up!”

Resources:

http://my.epilepsy.com/epilepsy/seizure_psychogenic

http://www.epilepsyfoundation.org/answerplace/Life/adults/women/Professional/nonepileptic.cfm

http://ehealthforum.com/health/what_is_epilepsy_-e113.html

http://emedicine.medscape.com/article/1184694-overview

http://www.associatedcontent.com/article/106466/what_are_pseudoseizures.html?cat=5

http://my.epilepsy.com/node/960097

http://hsc.usf.edu/COM/epilepsy/PNES_CCF.html

http://www.epilepsysociety.org.uk/AboutEpilepsy/Associatedconditions/Non-epilepticseizures

http://emedicine.medscape.com/article/1184694-overview

http://www.livestrong.com/article/53281-types-nonepileptic-seizures/

http://bftcounseling.com/partial-seizures-and-panic-attacks


38 Comments »

  1. Thank you for the info Phylis. I did not know that it could be Tourette.

    I prefer the correct term, NEAD. Non Epileptic Attack Disorder.

    Comment by Ruth Brown — December 28, 2010 @ 3:26 AM

  2. When I was writing the article, I got so confused by the terminology. Everyone seems to call “pseudo-seizures” something different.

    It took ME a while to dig through what they were saying, just to figure out which kind of seizure they were referring to.

    At first, I had a “glossary” at the bottom of the page, but that got confusing, too!

    Comment by Phylis Feiner Johnson — December 28, 2010 @ 9:54 PM

    • Well, I think you did a Great job of summarizing All that Info. :) And making it much easier to Interpret/Understand. Like I have always told ya, “You do a Good Job Writing”. And, I know from my own Research how difficult it must have been. :( We just had a ‘newbie’ on WebMD who is, also, confused by the many aspects of it all. What she has researched/read has left her totally confused. Can she read this article as a Non-member of your site? Or should I ask her to join you? :) Ya know how that goes. :) Lots of HUGS! And Hello Ruth! :)

      Love Candi

      Comment by candi — January 6, 2011 @ 1:31 AM

      • Hi Candi,

        Happy New Year…

        It’s GREAT to hear from you.

        No subscription is necessary, although she can subscribe if she wants. Her entry will just come up on my administrative board as a comment to approve or delete (for identity as spam.)

        Bring her on! :-)

        Best regards,
        Phylis

        Comment by Phylis Feiner Johnson — January 6, 2011 @ 10:16 PM

  3. I will! If/when she replies. :( Ya know how that goes. :(

    Happy New Year to You too. :) I just posted new Info from Medical News on my Facebook Page. :) And have you heard about the ‘new’ clinical trials for Epilepsy ‘nasal spray’. :) Stop seizures as they start. WOW!

    Love Candi

    Comment by candi — January 7, 2011 @ 2:05 AM

    • WOW indeed!!! :-)

      Can you send me the links to the new info from Medical News and the new clinical trials for Epilepsy nasal spray?

      Good for ALL forum members to know…don’t you think?

      Did you post it yet on WebMD???

      Comment by Phylis Feiner Johnson — January 7, 2011 @ 6:17 AM

      • Here is the Link: http://www.medicalnewstoday.com/articles/170486.php

        Oh, I Think the New Info I was referring to was about Global Underfunded Epilepsy Research & for some reason it didn’t make it to Facebook Page. :( But, as Far as I am concerned: That Was Old News! :( And I wrote them a Post & told them So!

        Ruth, if you like this Info you Can subscribe to this Journal/News. Just Register w/ their Site. :) I get an Email about once a mth about Any Health Issue I wanna Know More about. :)

        Love Candi

        Comment by candi — January 7, 2011 @ 10:48 PM

  4. Hi Candi,

    Every one is welcome. I look forward to meeting your friend. That is something to look forward to, the new clinical trials.

    Could you please put more of it here or e-mail me? I no longer belong to Facebook.

    I hope you are doing well. :D)

    Comment by ruth brown — January 7, 2011 @ 2:32 AM

    • Hi Ruth, I will continue to send info I get from Medical News Today. :) As it applies to us. :) It is Not a Facebook Site. I just sent it to My Facebook Page to Inform My friends There. :) You can register w/ Medical News Today to get the ‘Latest’ about Any Medical Condition. :)

      Love Candi

      Comment by candi — January 8, 2011 @ 9:22 AM

  5. Hi Candi,

    Thank you, I will register with the Medical News today. I appreciate the info.

    Comment by ruth brown — January 8, 2011 @ 11:31 AM

    • A million thanks for the link Candi. I registered for weekly updates (on epilepsy) from Medical News Today, also.

      And Ruth, you can learn all kinds of things about arthritis, osteo and share them on the forums you participate in.

      So you don’t need Facebook. Just the site, the links and the newsletter info!

      Comment by Phylis Feiner Johnson — January 9, 2011 @ 1:51 AM

  6. That’s Good Ruth. Then you can share Info You find interesting, too. :) I know you have other Health Issues. And I know How Much ya Like Learning the ‘Latest’ :) ENJOY! :)

    Love Candi

    Comment by candi — January 8, 2011 @ 7:05 PM

  7. For some reason it will not let me in the forum. It keeps saying that I have the wrong password. I know that it is the right password. Yesterday, I had the same problem. I did register. It also says that my e-mail address is not correct.

    One person with epilepsy in the forum is being given Thorazine by her neurologist. I want to let her know that Thorazine is an anti-pschycotic drug. It is very powerful. It has nothing to do with epilepsy, likes she thinks.

    Could you please help me out? We need to be careful of what meds we are taking. Any new one, I google on the internet and always get a lot of info on a med.

    Comment by ruth brown — January 9, 2011 @ 4:59 AM

  8. Hi Ruth, I have never registered for the Medical News forum. Maybe you should contact them? About your registration & failure to recognize your info/registration. :(

    Hopefully, someone who is registered will answer her, soon. :(

    Love Candi

    Comment by candi — January 16, 2011 @ 7:01 PM

  9. I’m thankful I remembered you wrote this story. It’s such a valuble resource to help someone I know who’s experiencing pseudo-seizure’s and doesn’t really understand what the doctor is telling her.
    Thank you, Phylis

    Comment by Charlie — October 24, 2011 @ 2:10 AM

  10. We are here to curing EPILEPSY. My name is vijay from India, My dad is yoga master and he is Ayurvedic Doctor also. We having medicine for EPILEPSY. This is not a fake message, any conformation please contact me my email id is vijayrathoda9@gmail.com

    http://www.sri-yogamuni.blogspot.con

    Comment by vijay — February 27, 2012 @ 9:14 AM

  11. Surprising Results from Study of Non-Epileptic Seizures

    A Loyola University Medical Center neurologist is reporting surprising results of a study of patients who experience both epileptic and non-epileptic seizures.

    Non-epileptic seizures resemble epileptic seizures, but are not accompanied by abnormal electrical discharges. Rather, these seizures are believed to be brought on by psychological stresses.

    Dr. Diane Thomas reported that 15.7 percent of hospital patients who experienced non-epileptic seizures also had epileptic seizures during the same hospital stay. Previous studies found the percentage of such patients experiencing both types of seizures was less than 10 percent.

    http://www.sciencedaily.com/releases/2012/12/121203081623.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine%2Fepilepsy+%28ScienceDaily%3A+Health+%26+Medicine+News+–+Epilepsy+Research%29

    Comment by Phylis Feiner Johnson — December 4, 2012 @ 10:41 AM

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    Comment by ways to overcome anxiety — December 15, 2012 @ 8:07 AM

  13. Hi “Ways”,

    Well the main things is that you’ve found us and WELCOME to our family!

    I think you’ll find everyone here both generous and caring, really sharing their experiences and trying to help each other.

    If you want to subscribe and get automatic updates, simple go to the bottom of the right column where it says “subscribe.”

    You might be interested in reading:

    10 Ways to Cope with Your Fear and Anxiety

    http://epilepsytalk.com/2012/05/18/10-ways-to-cope-with-your-fear-and-anxiety/

    Some Panic Attack Solutions…

    http://epilepsytalk.com/2012/10/09/some-panic-attack-solutions/

    Again, welcome!

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  15. Thank you! All compliments are welcome. :-)

    I usually post a new article every week. (The research, writing and editing take up the rest of my time.)

    If you’d like to subscribe to Epilepsy Talk and receive notifications of new posts by email, simply click on “Sign me Up!” at the bottom of the right column.

    Thanks for stopping by…

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    Comment by Yvonne — April 19, 2013 @ 9:16 PM

  17. Thank YOU for coming to visit and for the compliment.

    If you want to subscribe to Epilepsy Talk and automatically get the latest articles, just go to the bottom box of the right column and click on “Sign Me Up!”

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  19. Well Fatima,

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    I was an advertising writer for 30 years and my last largest freelance client was a health and wellness company.

    Which means a ton of research. (Or else the FDA will be at your door.)

    Thank you very much for the compliment. (All positives are welcome!)

    Thanks for visiting and thanks for sharing.

    If you want to subscribe to Epilepsy Talk and automatically receive notifications of new posts by email, simply click on “Sign Me Up!” at the bottom of the right column.

    Comment by Phylis Feiner Johnson — April 21, 2013 @ 10:55 AM

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    If you’d like to subscribe to Epilepsy Talk and receive notifications of new posts by email, simply click on “Sign Me Up!” at the bottom of the right column.

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  25. Paula, my advice to you is — just keep writing.

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  27. I’ve had seizures since age 9 recently in a SSI hearing the states specialist informs the. judge I’e been misdiagnosed @ i supposedly. have phesudo seizures . I’ve had a Vegas nerve stimulator put in___along with 3 different medications. but still have seizures i just need somesome input. from others to see if I’m the o_none trying to get a real diagnosis l_

    Comment by bo — November 1, 2013 @ 10:37 PM

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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I've also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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