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Psychogenic
Non-Epileptic
Seizures
What
are
psychogenic
non-epileptic
seizures?
A seizure
is a
temporary
loss
of control,
often
with
abnormal
movements,
unconsciousness
or both.
Epileptic
seizures
are caused by sudden
abnormal electrical
discharges in the brain.
Psychogenic
non-epileptic
seizures are attacks
that may look like
epileptic seizures,
but are not caused
by abnormal brain
electrical
discharges. They
are stress
or emotionally
related. They are
sometimes
called pseudoseizures,
but psychogenic non-epileptic
seizure (PNES) is
now the
preferred
term.
I
have
never
heard
of
this.
Is
it
rare?
- PNES
are
the
most
common
condition
misdiagnosed
as
epilepsy.
- PNES
are
not
rare,
with
a frequency
comparable
to
multiple
sclerosis.
- In
general,
one
in
five
patients
sent
to
epilepsy
centers
for
difficult
seizures
is
found
to
have
PNES
instead
of
epileptic
seizures.
How
can
you
be
sure
that
this
is
the
right
diagnosis?
Your physician may
suspect PNES when the
seizures have unusual
features, such as the
type of movements,
duration, triggers
and frequency. PNES
may look like generalized
convulsions (similar
to grand-mal seizures)
with falling and shaking.
They may also mimic
petit mal or complex
partial seizures with
temporary loss of attention,
unresponsiveness or
staring.
The
routine,
20-minute
electroencephalogram
(EEG)
is often
helpful
in diagnosing
epilepsy
because
it can
detect
the abnormal
electrical
discharges
in the
brain
that
indicate
epilepsy.
However,
the EEG
is very
often
normal
in patients
with
proven
epilepsy,
so it
cannot
be used
alone
to exclude
epilepsy.
The
best
test
to make
the diagnosis
is EEG-video
monitoring.
This
procedure
monitors
a patient
for several
hours
to several
days
with
a video
camera
and an
EEG until
a seizure
occurs.
By analyzing
the video
and EEG
recordings,
the diagnosis
can be
made
with
a nearly
100 percent
certainty.
It is
important
that
the recorded
seizures
are the
same
as that
patient
usually
experiences.
Sometimes
techniques
can also
be used
to trigger
seizures
during
monitoring.
What
causes
psychogenic
non-epileptic
seizures?
PNES,
unlike
epileptic
seizures,
are not
the result
of a
physical
brain
disease.
Rather,
they
are emotional,
stress-induced,
and result
from
traumatic
psychological
experiences,
sometimes
from
the forgotten
past.
It is
well
known
that
emotional
or psychological
stresses
or stressors
can produce
physical
reactions
in people
with
no physical
illness.
For example,
everyone
has blushed
in embarrassment
or been
nervous
and anxious
as part
of a "stage
fright" reaction.
Today,
we also
know
that
more
extreme
emotional
stresses
can actually
cause
physical
illnesses.
Some
physical
illnesses
can be
greatly
influenced
by psychological
or emotional
factors.
These
illnesses
are called
psychosomatic
or "mind-body" illnesses.
Examples
include
chest
pain,
asthma,
and headaches.
Many
other
conditions
are thought
to be
influenced
by stress
and are
often
associated
with
PNES,
including
fibromyalgia
and other
pain
syndromes,
and irritable
bowel
syndrome.
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