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 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 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

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