Epilepsy Talk

Epilepsy Versus “Pseudo-Seizures” | December 9, 2018

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 hypochondriac, 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 non-epileptic seizureshttp://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 commonhttp://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

 

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Resources:

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

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

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


2 Comments »

  1. The issue of Pseudo-Seizures still confuses me. On EEG’s, Complex Partial and Grand Mal seizures, that I have during the night, are picked up and stated as Epileptic Seizures. But I also have Simple Partial seizures morning, day, or evening. EEG’S have a hard time totally picking up those. They turn up as just little Blips on my brain waves, and neurologists call those
    “Non-Epileptic” seizures. Saying that they are due to an imbalance of chemicals, and not bio-electric charges in my brain. Even though I can’t stand my seizures, hearing a neurologist say that to me has always been very depressing.

    Liked by 1 person

    Comment by David Jensen — December 10, 2018 @ 4:51 PM

  2. EEGs are very superficial at best, only recording the surface of the brain.

    I know of people who have had 5 EEGs, only to be properly diagnosed when they finally had Video EEG Monitoring.

    Have you considered a VEEG?

    Video EEG Monitoring allows prolonged simultaneous recording of the patient’s behavior and the EEG.

    Seeing EEG and video data at the same time, permits precise correlation between seizure activity in the brain and the patient’s behavior during seizures.

    Video-EEG can be vital in the diagnosis of epilepsy and epileptic seizures.

    It allows the doctor to determine whether events with unusual features are epileptic seizures, the type of epileptic seizure, and the region of the brain from which the seizures arise.

    Continuous Video EEG Monitoring studies the brain waves over time.

    This can be accomplished through continuous Video EEG Monitoring, where a patient stays in a special unit for at least 24 hours.

    Antiepileptic medication is stopped for the duration of this test, since the objective is for seizures to occur so the abnormal brain waves they produce can be recorded.

    A video camera connected to the EEG provides constant monitoring, enabling the medical team to pinpoint the area where a seizure occurs and track the patient’s physiological response to the seizure.

    Continuous monitoring can also help distinguish between epilepsy and other conditions.

    It can characterize the seizure type for more precise medication adjustments and locate the originating area of seizures within the brain.

    I hope this helps, David.

    Like

    Comment by Phylis Feiner Johnson — December 10, 2018 @ 5:15 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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