Introduction
Psychogenic non-epileptic seizures result in an attack similar to epilepsy-related seizure, which is caused due to physiological problems and not by electrical brain activity. This condition shows symptoms and signs similar to seizure, and treatment associated with seizure will not help this condition. This condition can be treated through psychotherapy.
What Is Meant by Psychogenic Non-epileptic Seizures?
Psychogenic non-epileptic seizures, also known as pseudo seizures, resemble a seizure but are not. This condition shows symptoms similar to seizures but does not occur due to any brain electrical activity. Instead, it is caused due to physiological issues.
The psychiatric diagnosis of this condition is categorized as conversion disorder (also called a functional neurological symptom), as mental stress or pressure is displayed as physical symptoms. People affected by Psychogenic non-epileptic seizures will have experienced trauma. These people do not fake seizures as they do not have conscious or voluntary control. About 10 % to 15 % of people can have both PNES and epilepsies associated with seizures.
What Is the Causative Factor of Psychogenic Non-epileptic Seizures?
Psychogenic non-epileptic seizures are seen in people who have experienced stress, trauma, or other mental health issues. This can be caused due to any signal stressful event or long-term traumatic condition. People affected by this condition do not consciously pretend to have seizures and are unaware of the events that occur during seizure episodes. Some of the common causes include:
-
Past history of personality disorder.
-
Post-traumatic stress condition.
-
Dissociative disorder is a mental condition that causes detachment between thoughts, memories, and actions.
-
Depression or stress.
-
History of physical abuse.
-
Family issues.
-
History of traumatic brain injury.
-
Substance use.
-
Withdrawal issue or anger.
Conversion disorder is a condition where the mental health disorder is displayed as physical symptoms. Some physical conditions, such as long-term pain, can enhance the risk of Psychogenic Non-epileptic Seizures (PNES).
Who Is More Affected by Psychogenic Non-epileptic Seizures?
Psychogenic non-epileptic seizures can occur at any age, affecting women more than men. Some factor that enhances the risk of a person experiencing PNES are,
-
Person with a history of sexual abuse.
-
Individuals having experienced physical abuse in the past.
-
Psychiatric condition like
-
Depressive condition.
-
-
Suppression of emotion or stress.
About 20 % to 40 % who think they have a seizure are diagnosed with PNES.
What Signs and Symptoms Are Associated With Psychogenic Non-epileptic Seizures?
An important symptom of PNES is the occurrence of seizure-like episodes, which can vary in intensity, frequency, and pattern from person to person. They look very similar to epilepsies related to seizures, but they are caused due to emotional stress. Some people afflicted with this condition will have a false thought of having a tonic-clonic seizure where the whole body goes under spasm or shaking. Some others may experience small movements of jerking or twitching. Some people mimic absence seizures, where there will be a disconnect or lapse of attention. People affected by PNES can display any seizure-like episode. Some Common Symptoms Are:
-
Suddenly the person becomes unresponsive.
-
Alteration in consciousness.
-
Shaking or jerk movements.
-
Displaying cycling movements.
-
Closure of the eyes.
-
Movement of the head from side to side.
-
Clenching the teeth.
Some of the signs where the person displays symptoms related to PNES rather than seizures are:
-
The affected person may show symptoms of wild thrashing.
-
Head movements.
-
The affected people shout out phrases.
-
The eyes and mouth are closed, and the person resists opening them during the episode.
-
The person shows the response to loud noise or music.
-
There would be no drowsiness left by the person post-episode.
How Is PNES Diagnosed?
It is challenging for doctors to diagnose PNES just by observation and the symptoms experienced by the affected person as the signs and symptoms of both epilepsy associated with seizure and PNES are very similar. Most of the time, PNES is misdiagnosed as a seizure.
The doctors usually recommend EEG (electroencephalogram) to diagnose the PNES condition. This procedure places a metal disc called the electrode over the scalp. A machine is attached to these electrodes, which monitors the brain activity. This is the most effective way to diagnose PNES, as it records brain activity during seizure-like episodes. In the case of PNES, brain activity is normal, as no electrical activity is responsible for the PNES condition. The doctors also rule out other conditions responsible for such episodes. These are:
-
Sleep disorders.
-
Movement issues.
-
Partial seizure.
-
Absence seizure.
-
Fainting.
-
Vertigo.
Most of the affected people diagnosed with seizures, where the medications recommended will not show any results. These medications can cause harm if they are not needed to be taken.
A group of psychologists, psychiatrists, and neurologists will help to find the appropriate diagnosis and treatment.
How Can Psychogenic Non-epileptic Seizures Be Managed?
Anti-seizure drugs will not help to deal with the symptoms of PNES. This condition can be treated only when the underlying mental condition is treated. The best way to treat the symptoms of PNES is psychotherapy, also known as talk therapy. In this, there are sessions where the affected person talks out with a mental health professional like a psychologist. In these sessions, they discuss the situations that trigger emotional stress. The therapist helps to deal with the stressful condition more effectively.
Cognitive behavioral therapy (CBT) is one of the best methods for treating PNES, a form of psychotherapy. The therapies related to PNES focus on the following:
-
Educating the person regarding the type of seizure.
-
Identifying and preventing the trigger factors.
-
The past or present stressful condition that affects the seizure.
-
Relaxation training to enhance emotion management.
How Are Psychogenic Non-epileptic Seizures Prevented?
There is no particular way to prevent the occurrence of PNES. Addressing the underlying mental health condition can help to prevent this condition. Counseling or therapy sessions related to mental issues, like talk therapy exercises or relaxation practice, can help.
What Is the Outlook of Psychogenic Non-epileptic Seizures?
Any people who experience seizures frequently and the anti-seizure drugs do not cause any help should consult a doctor. If the person is affected by PNES, an alternative treatment can help. In the case of PNES, most affected people will not experience any seizure episodes after the diagnosis. So accepting the diagnosis can help significantly in preventing the occurrence of seizures. Addressing and treating the mental health condition responsible for PNES will also help greatly.
Conclusion
PNES is characterized by episodes resembling seizures, which are not attributable to abnormal brain electrical activity but are linked to mental health conditions such as stress, depression, or anxiety. This condition can be misdiagnosed as a seizure, and the doctors may recommend anti-seizure drugs, which will not help to manage this condition. Psychotherapy or CBT is the best mode of treatment in treating this condition.
