Pseudoseizures, also called psychogenic nonepileptic seizures (PNES), are seizures that occur as a result of psychological causes, such as severe mental stress.
Treating the underlying psychological cause can often help to reduce the number of seizures or prevent them happening.
It is easy to misdiagnose the condition as the symptoms are very similar to those of epilepsy, but this will result in the wrong treatment approach.
In this article, learn more about the causes and symptoms of pseudoseizures, as well as the treatment options.
What is a pseudoseizure?
Pseudoseizures are caused by psychological stress.
A pseudoseizure is a type of nonepileptic seizure that results from psychological conditions rather than brain function.
There are many types of seizure, which can range in severity from mild to a medical emergency. They fall into two general categories: epileptic and nonepileptic.
Doctors will diagnose someone who is experiencing epileptic seizures as having epilepsy, which is a condition that causes frequent bouts of seizures.
Typical epileptic seizures occur when a sudden electrical disturbance in the nerve cells in the brain causes the person to lose control of their body. The muscles in the body may jerk or seize up uncontrollably, and the person may also lose consciousness.
Nonepileptic seizures are seizures that occur in someone who does not have epilepsy.
According to the Epilepsy Foundation, pseudoseizures are common. Research shows that about 20 percent of people who attend epilepsy centers for electroencephalogram (EEG) monitoring are having pseudoseizures rather than epileptic seizures.
Symptoms
While pseudoseizures are distinct from epileptic seizures, their symptoms are similar. Symptoms of a pseudoseizure may include:
- involuntary muscle stiffening, convulsing, and jerking
- loss of attention
- loss of consciousness
- confusion
- falling down
- rigidity
- staring blankly
- lack of awareness of surroundings
As pseudoseizures are often the result of other mental health conditions, many people will also have symptoms relating to the underlying condition.
Causes
Pseudoseizures tend to result from mental health conditions and can often occur because of severe psychological stress. The stress may be due to a single traumatic event, or to an underlying chronic condition.
Conditions or disorders that could cause pseudoseizures include:
- anxiety or generalized anxiety disorder (GAD)
- panic attacks
- obsessive-compulsive disorder (OCD)
- attention deficit hyperactivity disorder (ADHD)
- substance abuse
- traumatic injuries
- ongoing family conflict
- anger repression or anger management issues
- emotional disturbance
- physical or sexual abuse
- post-traumatic stress disorder (PTSD)
- dissociative disorders
- schizophrenia
Pseudoseizures and their underlying causes can severely affect quality of life, so it is essential that people receive a proper diagnosis and treatment.
Diagnosis
An EEG may be performed to diagnose pseudoseizures accurately.
Diagnosing pseudoseizures can be difficult. It is rare that a doctor is present to witness a seizure and the symptoms that the individual describes will often match those of an epileptic seizure.
In many cases, a doctor will incorrectly diagnose a person with epilepsy and only consider pseudoseizures once the person does not respond to epilepsy medications.
Anyone who frequently has seizures that do not respond to epilepsy medication may need to stay in a specialty care unit to do video-EEG monitoring.
An EEG records and monitors a person’s brain activity on video, so that when they have a seizure, doctors have all the information they need to diagnose the condition.
If the EEG shows that there is no abnormal firing of neurons in the brain, the person may have PNES rather than epilepsy. The doctors will also watch the video of the seizure to look for any physical clues.
It often takes a team of psychologists, psychiatrists, and neurologists working together to diagnose and treat PNES.
Specialists can help identify any underlying psychological stress or conditions that could be triggering the pseudoseizures.
Treatment
Treatment for pseudoseizures varies considerably and will often focus on managing the symptoms of any mental health conditions or other stress factors.
In general, some treatments that may be effective for treating PNES include:
- individual or family counseling
- cognitive behavioral therapy (CBT)
- relaxation techniques
- behavioral therapy
- eye movement desensitization and reprocessing (EMDR) therapy, for traumatic memories
- antidepressants
- medications for underlying psychological issues
A psychiatrist will usually carry out a formal assessment to help determine the source of the trauma, disorder, or stress. They can then recommend medications or therapy specific to the underlying condition.
Working with a counselor, psychiatrist, or another licensed therapist is a vital part of treatment. Therapy can help people to identify the trauma or stresses affecting them and to learn new coping methods.
Source: Medical News today by By Jon Johnson
Reviewed by Seunggu Han, MD
