Epilepsy Talk

“Pseudo Seizures” AND Epilepsy – Yes You CAN Have BOTH! | May 2, 2016

Some know it as non-epileptic seizures (NES), psychogenic non-epileptic seizures  (PNES), or pseudoseizures. And then there’s epilepsy. Which is what?

What seizures all have in common is that they are usually sudden, short, and cause a change in the person’s awareness of where they are, what they are doing, what they are thinking or what they are feeling.

Some people have more than one type of seizure. For example, around 15 in every 100 people with non-epileptic seizures (NES) also have epilepsy.

And the numbers are all over the charts in reference to research…

Because non-epileptic seizures often are mistaken for epileptic seizures. While some patients who have both types can distinguish between the two, others find it difficult to distinguish when they are having non-epileptic seizures.

One study was done to evaluate the frequency of epilepsy in patients with psychogenic non-epileptic seizures (PNES). The evaluation was carried out during intensive VEEG monitoring in a diagnostic center for epilepsy in a university hospital.

Ninety-eight patients underwent intensive and prolonged video-electroencephalographic (VEEG) monitoring — out of these, a total of 28 patients presented PNES during monitoring.

Researchers concluded that the frequency of epilepsy in patients with PNES is much higher than that of previous studies, and point out the need, at least in some cases, for prolonging the evaluation of patients with PNES who have clinical histories indicating epilepsy.

Other reports showed that 5.3 to 73% of patients with PNES also showed epileptic symptoms.

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

Dr. Diane Thomas and colleagues reviewed 256 patients who had come to the hospital to have their seizures monitored. Seventy of the patients had documented non-epileptic seizures. Of these, 11 patients (15.7%) also experienced epileptic seizures during their hospital stays.

In previous studies, the percentage of such patients experiencing both types of seizures was less than 10%.

Another study had 22 patients in their sample who were referred on these grounds and, nine (41%) patients showed behaviors associated epilepsy. Although it’s an admittedly small study, it indicates that, even when the level of suspicion is high for PNES, coexistence of epilepsy may be a significant problem.

In this case, events initially diagnosed as nonepileptic actually prove to be epileptic. Frontal lobe seizures in particular may not be associated with significant EEG changes and therefore may be misdiagnosed as NES. That’s where the extended VEEG comes into play.

Unfortunately, since epileptic and nonepileptic seizures can be initially difficult to tell apart, people may at first become worried about the increase in their seizure frequency and this can cause the nonepileptic attacks to spiral more out of control. So, it becomes a real catch 22.

All this being said, psychogenic symptoms are still not the subject of much clinical research. Thus, there seems to be a severe disconnect between the frequency of the problem and the amount of attention devoted to it.

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Another article of interest:

Epilepsy Versus “Pseudo-Seizures”  https://epilepsytalk.com/2010/12/27/is-it-really-epilepsy/









  1. Wow! Amazing statistics! No wonder it’s so difficult to diagnose seizure types. You really have to be aware of the symptoms to know exactly what you’re dealing with. It is doubly difficult when you have both types. Thanks for sharing this Phylis!


    Comment by Soo Ihm — May 2, 2016 @ 3:22 PM

  2. It sure IS confusing! Thanks for posting Soo…


    Comment by Phylis Feiner Johnson — May 2, 2016 @ 3:32 PM

    • I think your article that you referenced “Epilepsy versus pseudo-seizures” explains the difference very clearly. Thank you very much for that!


      Comment by Soo Ihm — May 2, 2016 @ 3:46 PM

  3. THANKS for the compliment Soo!


    Comment by Phylis Feiner Johnson — May 2, 2016 @ 5:06 PM

  4. Mine doesnt show up, have had all test done nothing, i black out and then seize, im not on anything my dog senses them and lets me know.


    Comment by charlie — May 2, 2016 @ 7:57 PM

  5. It’s good that you’re dog is a “first responder”. You’re fortunate that way.

    But, I wonder. Has your doc recommended any anti-anxiety meds?


    Comment by Phylis Feiner Johnson — May 3, 2016 @ 10:23 AM

  6. So, because it’s difficult to distinguish between pseudo seizures and Epilepsy, Neurologists find it easier to just prescribe mind-numbing meds for everyone. How about both the meds and refer the patient for some kind of short term therapy to deal with the trauma of whatever it is you have or don’t have?


    Comment by Susan — May 3, 2016 @ 6:00 PM

  7. Sounds like a plan, Susan.

    I, myself, believe that therapy should be part of the deal. Unfortunately, others don’t. 😦


    Comment by Phylis Feiner Johnson — May 3, 2016 @ 6:56 PM

    • Who are these “others”? Neurologists or drug companies? Or is it just the public’s feeling that being in therapy means you might have a “mental illness?”. Honestly, what could be more crazymaking than dealing with the day to day details of life while zoned out on Depakote or another med, and wondering if a seizure might happen in the supermarket or a restaurant? There’s something called quality of life and being able to feel ok about being in the here and now that I thing E patients aren’t helped with.


      Comment by Susan — May 4, 2016 @ 3:13 PM

  8. Susan, I think it’s the mental help stigma.

    If you can’t cope, you’re weak. You know “chin up” and all that stuff.

    If I had kept my “chin up” all these years, I’d probably be dead in the water, but who are WE to say?

    As for the mental and psychological side-effects of AEDs, it’s just a matter of “you’re taking the wrong med”, or worse yet “we should up the dose”, adding insult to injury.


    Comment by Phylis Feiner Johnson — May 4, 2016 @ 3:26 PM

  9. I was told I had non-epileptic seizure,s is that way they don,t go there the whole seizure. and all I fell just the warning,s


    Comment by michele metzger — June 2, 2016 @ 1:46 PM

  10. Correct, you can “pseudo seizures” without having epilepsy.

    Perhaps this article will help:

    Epilepsy Versus “Pseudo-Seizures”



    Comment by Phylis Feiner Johnson — June 2, 2016 @ 2:39 PM

  11. Thank you so much for this article! it gives me some validation. I have both epileptic and non-epileptic, an they diagnosed me with conversion disorder with the non-epileptic ones. My non-epileptic ones can be so much more physically dangerous that my family have often wandered how they were not epileptic.


    Comment by Lynn McPherson Palmer — June 3, 2016 @ 8:36 AM

  12. Well your “non epileptic” seizures are actually simple partial seizures, but it sounds like they’re morphing into full blown seizures.


    Comment by Phylis Feiner Johnson — June 3, 2016 @ 11:28 AM

  13. Thanks for this and the ’40 types of seizures’ article. I’ve got real epilepsy but I’ve always had strange things, ‘clicking out’ for a few seconds etc. I was diagnosed with PTSD due to violence in N Ireland 3yrs ago, studied it to find out if it could have caused my epilepsy and yes, it could have so I insisted on having a review. I’ve just been told I’ve got these psychogenic types, probably because I’m trying to get out of a dangerous world, and I’m being sent to a pyschiatrist. the 40 types of siezures listed some ones that happen to me but I didn’t think they were epileptic. Thanks for all that help


    Comment by Miss Gail J Barry — June 22, 2016 @ 3:26 AM

  14. Gail, you probably know all about PTSD.

    PTSD affects about 7.7 million American adults, and while it’s impossible to predict who will develop PTSD in response to trauma, there are certain risk factors that increase your vulnerability.

    Of course, the first thought is of veterans. But anyone can get PTSD at any age.

    Going through trauma is not rare. About 6 out of every 10 (or 60%) of men and 5 of every 10 (or 50%) of women experience at least one trauma in their lives.

    While the symptoms of PTSD most commonly develop in the hours or days following the traumatic event, it can sometimes take weeks, months, or even years before they appear.

    Some of these risk and resilience factors are present before the trauma and others become important during and after a traumatic event.

    The symptoms of post-traumatic stress disorder can arise suddenly, gradually, or come and go over time.

    Sometimes symptoms appear seemingly out of the blue.

    At other times, they are triggered by something that reminds you of the original traumatic event, such as a noise, an image, certain words, or a smell.

    PTSD and Military Conflict

    Roadside bombs and other blasts have made head injury the “signature wound” of the Iraq and Afghanistan conflicts.

    Most combat veterans recover from mild traumatic brain injury, also known as concussion, but a small minority experience significant and long-term side effects.

    If you are in the military, you may have seen combat. You may have been on missions that exposed you to horrible and life-threatening experiences.

    You may have been shot at, seen a buddy shot, or seen death. These are types of events that can lead to PTSD.

    Experts think PTSD occurs:

    In about 30% of Vietnam Veterans, or about 30 out of 100 Vietnam Veterans…

    In as many as 10% of Gulf War (Desert Storm) Veterans, or in 10 Gulf War Veterans out of 100…

    In about 11-20% of Veterans of the Iraq and Afghanistan wars (Operations Iraqi and Enduring Freedom), or in the range of 11-20 Veterans out of 100 who served in OEF/OIF.

    The Next Steps for PTSD Research

    In the last decade, rapid progress in research on the mental and biological foundations of PTSD has led scientists to focus on prevention as a realistic and important goal.

    For example, NIMH-funded researchers are exploring new and orphan medications thought to target underlying causes of PTSD in an effort to prevent the disorder.

    Other research is attempting to enhance cognitive, personality, and social protective factors and to minimize risk factors and ward off full-blown PTSD after trauma.

    Still other research is attempting to identify what factors determine whether someone with PTSD will respond well to one type of intervention or another, aiming to develop more personalized, effective and efficient treatments.

    As gene research and brain imaging technologies continue to improve, scientists are more likely to be able to pinpoint when and where in the brain PTSD begins.

    This understanding may then lead to better targeted treatments to suit each person’s own needs or even prevent the disorder before it causes harm.

    Also, researchers at Albert Einstein College of Medicine of Yeshiva University, in cooperation with Resurrecting Lives Foundation, are using advanced MRI technology and psychological tests to investigate the structural and biological impact of repeated head injury on the brain and to assess how these injuries affect cognitive function.

    “Right now, doctors diagnose concussion purely on the basis of someone’s symptoms,” said Michael Lipton, M.D., Ph.D., associate director of Einstein’s Gruss Magnetic Resonance Research Center.

    “We hope that our research will lead to a more scientifically valid diagnostic technique — one that uses imaging to not only detect the underlying brain injury but reveal its severity.

    Such a technique could also objectively evaluate therapies aimed at healing the brain injuries responsible for concussions.”

    An award-winning site for trauma information and support can be found at: http://www.trauma-pages.com/support.php


    Comment by Phylis Feiner Johnson — June 22, 2016 @ 9:56 AM

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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I 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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