Psychogenic Non-Epileptic Seizures

What is a nonepileptic seizure?
A nonepileptic seizure is the result of subconscious mental activity or distress. It is not the result of abnormal brain electrical activity. Doctors consider most of these episodes psychological in nature, but not purposely produced. Therefore, the older term “pseudoseizures” has fallen out of favor. The person is usually unaware that the seizures are not epileptic. Nonepileptic seizures most often resemble complex partial or tonic-clonic seizures. The degree of resemblance varies considerably, often making diagnosis difficult.

How common are nonepileptic seziures?

Nonepileptic seizures are most common in adolescents and adults but also can occur in children and the elderly. They are three times more likely in females. These episodes have been more widely recognized during the past several decades. In comprehensive epilepsy centers, where video-electroencephalogram (video-EEG) monitoring is performed, approximately 20% of referred patients are found to have nonepileptic seizures.

How are non-epileptic seizures diagnosed?
The diagnosis of nonepileptic seizures is most often made with video-EEG monitoring. Doctors often try to have a family member or friend observe the recorded event to ensure that it is identical or nearly identical to the usual episodes. Certain tests may be safely used to help provoke a seizure of this kind.

How are nonepileptic seizures treated?
The treatment of nonepileptic seizures varies. In some cases the episodes subside when the patient learns that they are not epileptic seizures and are not due to a serious neurological disorder. Nonepileptic seizures are not necessarily an indication of a serious psychiatric disorder, but the underlying problem needs to be addressed and, in most cases, treated. There may be coexisting depression or anxiety that can be helped with medication. The prognosis for control of these episodes and for the patient’s psychological well-being varies. Counseling with a psychologist, psychiatrist, or clinical social worker for some period of time after the diagnosis is a mainstay to successful treatment.

Is it dangerous to treat nonepileptic seizures as if they are epileptic?
Absolutely! It is very important to diagnose whether seizures are epileptic or nonepileptic, as the treatments vary widely. Why expose a patient with nonepileptic seizures to antiepileptic medications with their associated risks and side effects? As importantly, repetitive non-epileptic seizures in a patient may mimic a very serious and dangerous condition, status epilepticus, for which doctors would administer sedating intravenous medications, often requiring intubation (putting a tube in the patient’s throat to help with breathing), thus exposing the patient to unnecessary invasive procedures.

Can a patient with nonepileptic seizures also have epileptic seizures?
Patients with nonepileptic seizures may also have epileptic seizures. As a matter of fact, epilepsy centers have shown that anywhere from 10-40% of patients with nonepileptic seizures also have epileptic seizures. This makes diagnosis of the different spells very important, as treatment for each type is so different.


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