Non-Epileptic Seizures

Doctors consider most of them to be psychological in nature, but not intentionally produced. Although not epilepsy, these events are very real and can be very distressing for the patient and the family. Usually the person is not aware that the spells are not “epileptic.” Common names include “psychogenic seizures” (si-ko-JEN-ik), which means beginning in the mind and “pseudo-seizures.”

Are they common?

Non-epileptic events are common. About 20 percent of the patients referred to comprehensive epilepsy centers for study with video-EEG are found to have non-epileptic seizures. However, about 1 in 6 of these patients either also has epileptic seizures or has had them. These people need different treatment for each disorder. Psychogenic non-epileptic events have been more widely recognized during the past several decades. They are most often seen in adolescents and young adults, but they can also occur in children and the elderly. They are three times more common in females.

What do they look like?

These events most often imitate epileptic seizures, most often the complex partial or the tonic-clonic (grand mal) types. Family members report episodes in which the patient has a blank stare with unresponsiveness or stiffens and jerks.

Non-epileptic seizures (NES) or events can be divided into two types: organic and psychogenic.

Organic non-epileptic events: have a physical cause (relating to the body). Examples include fainting (syncope) and metabolic causes (a result of certain biochemical processes in the body) such as diabetes. Because they have a physical cause, they may be relatively easy to diagnose and the underlying cause can be found.

Psychogenic non-epileptic events: The term “Psychogenic” means they are caused by mental or emotional processes, rather than by a physical cause. Psychogenic events may happen when someone’s reaction to painful or difficult thoughts and feelings affects them physically. They include different types:

• Dissociative events happen unconsciously, which means that the person has no control over them and they are not “faking it.” This is the most common type of non-epileptic events.
• Panic attacks can happen in frightening situations, when remembering previous frightening experiences or in situations that the person expects to be frightening. Panic attacks can cause sweating, palpitations (being able to feel your heart beat), trembling and difficulty breathing. The person may also lose consciousness and may shake (convulse).
• Factitious events means that the person has some level of conscious control over them. An example of this is when a person is driven by a need to seek attention or have medical investigations and treatments.

How are they recognized?

Doctors have identified certain kinds of movements and other patterns that seem to be more common in psychogenic non-epileptic events than in seizures caused by epilepsy. Some of these patterns do occur occasionally in epileptic seizures, so having one of them does not necessarily mean that the seizure was non-epileptic.

How are non-epileptic seizures diagnosed?

If you have seizures, your family doctor will usually refer you to a specialist for diagnosis. This will usually be a neurologist or epileptologist to first see if the seizures are epileptic. It may be easier for doctors to try and rule out possible physical causes first, including epilepsy. This will influence the types of tests you might have.

Medical tests

Some tests are used to rule out other causes of events, including epilepsy.

• Medical examinations and blood tests can be used to check your overall health and see if your events have a physical cause such as diabetes.
• Brain scans such as CT (Computerized Tomography) or MRI (Magnetic Resonance Imaging) are used to form a picture of your brain. This may show a physical cause for epileptic seizures but would not usually be helpful in diagnosing NES.
• An EEG (electroencephalogram) records the electrical activity of the brain. It is often used to see if events are caused by disrupted brain activity, which helps to diagnose epilepsy. NES are not caused by changes in brain activity.
• Video-EEG involves having an EEG and being filmed at the same time. This compares what a person is doing with what is happening in their brain during the event and can often show the difference between epileptic and non-epileptic events.

If the tests show no neurological or physical cause for your events, and your specialist thinks it might be NES you may be referred to a psychiatrist or a psychologist for diagnosis.

Can they be treated?

Psychogenic non-epileptic events do not necessarily indicate that the person has a serious psychiatric disorder. 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. The person needs to accept the diagnosis (at least as a possibility) and follow through with therapy.

Treatment options

Treatment may depend on the cause of your events and your medical history. Your specialist will talk to you about what treatment options might be helpful.

Medication

Events that are not epileptic will not be controlled by anti-epileptic drugs (AEDs).

• If you already take anti-seizure medications, for example if you were previously mis-diagnosed with epilepsy, your specialist may suggest you gradually reduce them.
• If you have both epilepsy and NES, your doctor will help you and your family recognize the epileptic seizures from the non-epileptic events and will continue to treat the epileptic seizures with anti-seizure medications.
• If you also have anxiety or depression, your specialist might talk to you about whether other medications, such as anti-depressants, might be helpful.

Other forms of treatment

• Psychotherapy is the most commonly recommended treatment for NES. Psychotherapy is the name for a form of therapy which involves counseling rather than medication. Mental health professionals, including psychiatrists and psychologists, are trained in different forms of psychotherapy.
• Cognitive behavioral therapy (CBT) is often recommended for NES. It looks at how you think about things, how this affects you physically and emotionally and how it affects what you do (your behavior). By changing the way you think about yourself, other people and the world around you, this may change the way that you behave. CBT tends to focus on how things are affecting you in the present and ways to help you view current situations more positively and cope with stressful events.