Epilepsy Talk

“Pseudo Seizures” AND Epilepsy – Yes, You CAN Have BOTH!  | September 12, 2025

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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Resources:

https://www.yalemedicine.org/news/seizure-epilepsy

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+&+Medicine+News+–+Epilepsy+Research%29

http://www.neuropsychiatry.co.nz/non-epileptic-attacks/

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2010000200003

https://www.brainandlife.org/articles/the-seizures-no-one-wants-to-talk-about#:~:text=Because%20the%20underlying%20causes%20of%20PNES%20and,such%20as%20vagus%20nerve%20stimulation%20and%20surgery.

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