Psychogenic Nonepileptic Seizures

Psychogenic nonepileptic seizures (PNES) refer to seizures that occur as a result of psychological causes. Unlike nonepileptic seizures, PNES are not triggered by underlying physical issues, and they are not brought on by unusual electrical activity in the brain, which is the cause of epileptic seizures.

How Are Psychogenic Nonepileptic Seizures Different Than Epilepsy?

While epileptic seizures are the result of sudden, chaotic electrical discharges in the brain, psychogenic nonepileptic seizures occur due to overwhelming emotional or mental distress. Consequently, antiepileptic drugs will not be effective in treating psychogenic nonepileptic seizures because the reason for the onset of seizures is different from epilepsy.

Epilepsy is ranked as the fourth most common neurological issue in the world, and affects approximately 2.2 million people in the United States. However, research shows that about 1 in 5 people who are admitted to epileptic centers are actually affected by PNES and not epilepsy. Though both types of seizures result in similar symptoms—which often results in misdiagnoses for those experiencing them—specialists have noted some common trends in people affected with PNES, such as gradual onset, disorganized motor activity, and the long duration of seizures. However, these trends are not definitive in diagnosing PNES as people affected by epilepsy may occasionally exhibit these symptoms as well.

After determining that seizures are not caused by underlying physical issues, the most effective way of diagnosing psychogenic nonepileptic seizures is by using video electroencephalogram (EEG) monitoring. During these sessions, doctors will attempt to induce a seizure while paying attention to a person’s brain electrical activity. If disrupted brain activity is seen during the seizure, a diagnosis of epilepsy may be made; however, if brain activity remains unaffected during the seizure, a diagnosis of PNES may be made. Doctors may also ask family members to view the recording and confirm if the behavior observed during the session is consistent with the behavior seen at home during a seizure.

Types of Psychogenic Nonepileptic Seizures

There are three main types of psychogenic nonepileptic seizures. These include:

• Dissociative seizures: These seizures are uncontrollable and occur unconsciously. An individual may dissociate or split off from his or her emotions about a painful memory due to his or her inability to cope with the feelings and sensations associated with that past experience. In essence, the body drowns out the frightening memory and prevents it from entering conscious thought. This is the most common type of nonepileptic seizure.

• Panic attacks: Usually triggered during exposure to frightening or highly stressful situations, panic attacks may cause heart palpitations, excessive sweating, trembling, breathing issues, convulsions, and/or loss of consciousness.

• Factitious seizures: During these seizures, the affected person has a measure of conscious control. Individuals experiencing Münchausen’s syndrome may display this type of seizure.

Symptoms of Psychogenic Nonepileptic Seizures

Individuals experiencing psychogenic nonepileptic seizures may display a variety of symptoms associated with the condition. Some of the most common symptoms are:

• Heart palpitations
• Ictal crying
• Involuntary vocalizations
• Shakiness
• Difficulty breathing
• Increased perspiration
• Uncontrollable body movements
• Asymmetrical limb movements
• Thrusting pelvic movements
• Side-to-side head movements
• Closed eyes during the event
• Resistance to eyelid opening
• Convulsions
• Prolonged duration of seizures (2 to 3 minutes)
• Loss of consciousness

Risk Factors for Psychogenic Nonepileptic Seizures

Psychogenic nonepileptic seizures are most likely to be seen in young adults and people with low stress resilience. PNES are more common in women, with one study (2013) estimating 75-85% of all affected people are female.

Psychological health may also play a role as people experiencing conditions such as depression, anxiety, and personality issues are more likely to develop PNES. Additionally, individuals who have been exposed to highly traumatic events such as motor vehicle accidents, divorce, bullying, physical abuse, sexual abuse, or the death of a loved one may be at increased risk for the condition.

Treatment for Psychogenic Nonepileptic Seizures

While there is no definitive cure for psychogenic nonepileptic seizures, psychotherapy has proven to be an effective treatment. A report published by the University of South Florida School of Medicine indicates over 70% of people who find a therapist and receive adequate therapeutic care experience no more seizures. A therapist may help educate affected people about PNES, uncover repressed psychological material, and help a person work on mental health concerns.

For example, cognitive behavioral therapy may be used to help a person readjust his or her thinking and future reactions to stressful situations. People with comorbid issues such as anxiety and depression may be given medication and taught effective coping strategies for these conditions. Relaxation techniques are also effective in helping individuals manage stress.

References:

1. Alsaadi, T. M. and Marquez, A. V. (2005). Psychogenic nonepileptic seizures. American Academy of Family Physicians, 72(5), 849-856. Retrieved from http://www.aafp.org/afp/2005/0901/p849.html
2. Benbadis, S., and Heriaud, L. (n.d.) Psychogenic (non-epileptic) seizures: a guide for families and patients. University of Southern Florida College of Medicine. Retrieved from http://hsc.usf.edu/COM/epilepsy/PNESbrochure.pdf
3. Devinsky, O. (2013). Nonepileptic seizures or events. Retrieved from http://www.epilepsy.com/learn/types-seizures/nonepileptic-seizures-or-events
4. Epilepsy Foundation. (n.d.). The truth about psychogenic nonepileptic seizures. Retrieved from http://www.epilepsy.com/article/2014/3/truth-about-psychogenic-nonepileptic-seizures
5. Epilepsy Society. (2015). Non-epileptic seizures. Retrieved from http://www.epilepsysociety.org.uk/non-epileptic-seizures#.Vkm3PnarTIU
6. Patidar, Y., Gupta, M., Khwaja, G. A., Chowdhury, D., Batra, A., and Dasgupta, A. (2013). Clinical profile of psychogenic non-epileptic seizures in adults: A study of 63 cases. Annals of Indian Academy of Neurology, 16(2), 157–162. http://doi.org/10.4103/0972-2327.112451
7. Schafer, P. O. and Sirven, J. I. (2014). Epilepsy statistics. Retrieved from http://www.epilepsy.com/learn/epilepsy-statistics

Last Updated: 12-1-2015