Epilepsy Talk

“Pseudo Seizures” AND Epilepsy – Yes, You CAN Have BOTH! | October 2, 2018

Some know it as non-epileptic seizures (NES), psychogenic non-epileptic seizures  (PNES), or “pseudo seizures”.

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.

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 non-epileptic 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 non-epileptic 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 non-epileptic 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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  1. Hi Phylis

    It is a catch 22, normally a TC would be caught on a video telemetry EEG but it’s the focal seizures that are difficult to catch, there is no way of definitively proving that a focal seizure is epilepsy or PNES, that’s my situation, annoying, 11 years now and they don’t know if my seizures is epilepsy or PNES or as you say both.
    Just because a seizure doesn’t show up on an EEG, doesn’t mean alot and I’m not surprised that there isn’t more people are misdiagnosed

    Liked by 1 person

    Comment by Mark — October 2, 2018 @ 11:44 AM

    • Mark, you might find this article interesting:

      Beyond EEGs — Diagnostic Tools for Epilepsy



      Comment by Phylis Feiner Johnson — October 2, 2018 @ 11:49 AM

      • Thanks for the link, all useful tools had most of those, still no diagnosis of the vocals especially when they are simple ones.

        They have started hone video telemetry EEG over here now in some hospitals, exactly the same as a hospital video telemetry EEG but it’s on a laptop that you can take home with you, maybe you have the same in the states ?

        Liked by 1 person

        Comment by Mark — October 2, 2018 @ 1:33 PM

      • Yes, Mark. We finally have Ambulatory EEGs that can be done at home at a MUCH lower cost.

        Here’s what I found on the net (all of which I’m sure you’ve done) RE: Focal Seizures

        Depending on your symptoms and your medical history, your doctor may run any number of tests, such as brain imaging scans, blood tests, or a spinal tap to find out the cause of your seizures.


        Can other health conditions look like focal aware seizures?

        “Yes, some symptoms of focal onset aware (simple partial) seizures are similar to other health conditions.

        Health symptoms or problems, such as nausea or pain from stomach disorders or tingling and numbness from a pinched nerve, can be mistaken for focal seizures.

        Hallucinations (smells, tastes, sounds, visions) can accompany psychiatric illness or the use of certain drugs.

        Some symptoms (such as déja vu) are experienced by almost everyone at some time.

        Temporary numbness or weakness in a limb or the face sometimes occurs from a transient ischemic attack (TIA), which can be a serious warning sign for a future stroke.

        Migraines, with or without a significant headache, can produce visual, tingling, or other symptoms that can be confused with a seizure.

        Your health care provider can help determine whether your symptoms may be focal aware (simple partial) seizures or some other condition.” https://www.epilepsy.com/learn/types-seizures/focal-onset-aware-seizures-aka-simple-partial-seizures

        Sorry I couldn’t give you more helpful input. 😦


        Comment by Phylis Feiner Johnson — October 2, 2018 @ 3:14 PM

  2. Reblogged this on catsissie.


    Comment by catsissie — October 2, 2018 @ 1:08 PM

  3. Does it really matter what kind of seizures one has?

    Liked by 1 person

    Comment by Elizabeth Masten — October 2, 2018 @ 3:14 PM

  4. Hi thx for link, I was diagnosed 8ish years ago. Had been having seizures for 8+ years prior, did ambalatory eeg, ecg, blood tests, mris, cts, pee test, nothing came back as significant. Neurologist asked partner to film on phone when I had a seizure, within 30 secs told me I had pnes! That they couldn’t help me as there are no meds, only therapy might help! Now after another ride to hospital with dislocated and broken toes…. Dr’s now tell me I have megloblastic seizures as well as pnes! Therapy was withdrawn because of no staff or resources! So partner dealing with Everything! Not sure how much more she can take 😦

    Liked by 1 person

    Comment by Jp Arnold — November 26, 2018 @ 4:53 AM

  5. Thanx for info Phylis, I am already on folic acid, magnesium, b12 injections, vit d, k, a supplements, along with potassium and calcium supplements, also antidepressants. Was told I had pernicious anemia, megloblastic red blood cells hence seizures. Am under investigation for a malabsorbtion issues but been told will be on supplements for life… Do you know how hard it is to get to see a neurologist here? I have my diagnosis and that is that! Can’t help only therapy will help? I do everything I am told and just seems to be, I sort out 1 issue another pops up… my seizures are always a constant though…

    Liked by 1 person

    Comment by Jp Arnold — November 26, 2018 @ 12:26 PM

  6. Thank you so much for posting this. This issue is so sensitive to me, because the way we are often treated with neurologists about it. I was told I have both, but sometimes when I have this type that is supposed to be “Pseudo”, I will fall immediately to sleep, the same thing I will do with the epileptic. I feel like it is stigmatized, because there is still so much to learn about it, so it is thrown to the side.

    Liked by 1 person

    Comment by Lynn Palmer — November 8, 2019 @ 9:38 AM

    • I couldn’t agree more. The fact that “pseudo” seizures are discredited affects all of those with epilepsy.


      Comment by Phylis Feiner Johnson — November 8, 2019 @ 9:40 AM

  7. Thank you for your reply of advice about non-epileptic fits which my sister thinks I’m having. The last time, aas far as I’m aware I remember having the shower then was in my bedroom. I also know I picked a dress (at time i thought it was a nightie) I was trying to find the straps for quite a while then threw it down gave up, walked around bottom of the bed and went to drawer and got one out put it on (strange thing is I don’t normally have nightie on just briefs) normally I don’t remember what I’ve done but when I come round I’m normally covered in bumps and bruising and see damage I’ve done.

    Liked by 1 person

    Comment by Clare Armstrong — June 9, 2020 @ 6:07 AM

    • Oh Clare, that’s miserable. I’d guess you have some sort of Temporal Lobe Epilepsy.

      The seizures associated with temporal lobe epilepsy consist of simple partial seizures without loss of awareness and complex partial seizures, with loss of awareness. You lose awareness during a complex partial seizure because the seizure spreads to involve both temporal lobes, which causes impairment of memory. The result is complex partial seizures coupled with simple partial seizures. Generalized tonic clonic seizures may be part of this syndrome as well.

      Another possibility is Absence Seizures. (“Petit Mal”)

      Absence seizures account for 2-4 percent of epilepsy. They are characterized by brief episodes of staring, usually lasting only 2-10 seconds and may happen repeatedly during the day. There is no warning before a seizure and the person is completely alert afterwards, with no memory of it. Because they are so mild, you might not even realize you had one and it’s easily not noticed by those around you.

      See Updated — 40+ Different Kinds of Seizures https://epilepsytalk.com/2018/11/29/updated-40-different-kinds-of-seizures/

      As for your sister, don’t engage her behavior, but suggest she come to your next neuro appointment.


      Comment by Phylis Feiner Johnson — June 9, 2020 @ 9:59 AM

      • Hi Phylis
        It’s Clare I was one that you replied to last year 😊 I was at my neurologist on Mon and now he has seen a recording I did of me having the fits he has said that there are non-epileptic as well as epileptic so not sure what they can do now

        Liked by 1 person

        Comment by Clare — May 15, 2021 @ 3:02 PM

  8. Well, for the epileptic seizures, you’ll be prescribed anti epilepsy drugs. (AEDs)

    For the non epileptic seizures, probably counseling will be suggested. Often, the non epileptic seizures dissipate with therapy.

    I hope things work out for you.


    Comment by Phylis Feiner Johnson — May 15, 2021 @ 6:47 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 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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