• Psychogenic Nonepileptic Seizures

    (Pseudoseizures)

    Definition

    Psychogenic nonepileptic seizures (PNES) are seizure-like movements, sensations, or behaviors. Though PNES may appear similar to epileptic seizures, they have very different causes.

    Causes

    Most seizures are caused by problems with electrical signals in the brain or brain injury.
    However, PNES are not caused by these types of problems. The symptoms are actually caused by psychological factors such as intense emotions, traumatic experiences, or stress. Other psychological conditions such as depression are also present.
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    Risk Factors

    Factors that may increase the risk of PNES include:
    • History of physical trauma, especially sexual trauma
    • A recent traumatic event, such as a divorce or the death of a loved one
    • Family history of epilepsy
    • Risk factors specific to children include:
    • Difficulties in school
    • Family conflict
    • Interpersonal conflicts, such as bullying

    Symptoms

    PNES symptoms may include:
    • Loss of consciousness
    • Staring
    • Shaking, uncontrollable muscle movement, and falling
    PNES may differ from epilepsy in that PNES symptoms do not usually include:
    • Loss of bladder or bowel control
    • Confusion, headache, and fatigue that occurs after an epileptic seizure
    • Eyes that remain open
    • Inability to speak

    Diagnosis

    You will be asked about your symptoms and medical and mental health history. The doctor will ask questions about the seizure such as what happens during them, how long they last, and how you feel after. A physical exam will be done. You may be referred to a doctor that specializes in the nervous system and the brain.
    Blood tests and brain scans may be done to look for potential causes of seizures, if the cause is not clear.
    An EEG is a test that shows the electrical activity in the brain. This test can help identify electrical problems in the brain associated with seizures. An EEG is most effective when done while video monitoring. If a seizure is seen on video but there is no change in EEG, PNES is diagnosed.

    Treatment

    Managing underlying psychological issues will stop seizures.
    Medications will not help in managing pseudoseizures. However, you may be given medications to treat underlying conditions or mental health conditions.
    Mental health therapy is designed to help cope with stressors, change thought patterns, and learn new behaviors. You will be referred to a mental health therapist for evaluation and treatment. Types of therapy may include psychotherapy, cognitive-behavioral therapy, and group therapy.

    Prevention

    There is no known ways to prevent PNES.

    RESOURCES

    Citizens United for Research in Epilepsy (CURE) http://www.cureepilepsy.org

    Family Doctor—American Academy of Family Physicians http://www.familydoctor.org

    CANADIAN RESOURCES

    Epilepsy Canada http://www.epilepsy.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Alsaadi T, Marquez A. Psychogenic nonepileptic seizures. Am Fam Physician. 2005 Sep 1;72(5):849-856.

    Non-epileptic seizures. Epilepsy Society website. Available at: https://www.epilepsysociety.org.uk/non-epileptic-seizures#.Vwe7rnpuN8E. Published March 2015. Accessed April 11, 2016.

    Psychogenic (non-epileptic seizures): A guide for patients and families. USF Health website. Available at: http://hsc.usf.edu/COM/epilepsy/PNESbrochure.pdf. Accessed April 11, 2016.

    Psychogenic nonepileptic seizures. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116939/Psychogenic-nonepileptic-seizures. Updated January 27, 2016. Accessed April 11, 2016.

    Shahid A, Shagufta J, et al. How to use your clinical judgment to screen for and diagnose psychogenic nonepileptic seizures without video electroencephalogram. Innov Clin Neurosci. 2011. Jan;8(1):36-42. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036551. Accessed April 26, 2016.

    Symptoms that mimic epilepsy linked to stress, poor coping skills. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/news/media/releases/symptoms%5Fthat%5Fmimic%5Fepilepsy%5Flinked%5Fto%5Fstress%5Fpoor%5Fcoping%5Fskills. Published April 10, 2012. Accessed April 11, 2016.

    The truth about psychogenic nonepileptic seizures. Epilepsy Foundation website. Available at: http://www.epilepsy.com/article/2014/3/truth-about-psychogenic-nonepileptic-seizures. Accessed April 11, 2016.

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