Psychogenic non-epileptic seizures. What to do?

What are psychogenic non-epileptic seizures? Is treatment necessary and what is the prognosis for the future? Epileptologist Prof. Uri Kramer answers.

Psychogenic non-epileptic seizures (PNES or epilepsy pseudo – seizures) are, in most cases, a conversion reaction (the manifestation of symptoms associated with some psychological conflict or problem), which is similar from a psychiatric point of view to a hysterical reaction. Physical manifestations are a reaction to a psychological factor, usually stress.

Usually, psychogenic non-epileptic seizures begin in children after 10 years of age. In rare cases, they occur at an earlier age. In most cases, the peak onset of the disease occurs between the ages of 15 and 25 in women. The age of onset of the disease and the fact that this deviation is more common in women indicates a similarity with a hysterical reaction.

Some children and adults with psychogenic non-epileptic seizures have psychiatric comorbidities:

• depression;
• panic;
• dissociative disorders;
• personality disorders.

Naturally, these seizures are not controlled by antiepileptic drugs and do not lead to brain damage.

In epileptic centers that conduct video-EEG monitoring before surgery for epilepsy, it is found that about 20% of women sent for preoperative checks suffer from non-epileptic seizures. They are very similar in their manifestation to epileptic seizures, but we are not talking about epilepsy.

non-epileptic seizures differ from true epileptic seizures?

Epileptologists, in the vast majority of cases, will be able to distinguish between psychogenic non-epileptic seizures and real epileptic seizures by several factors:

• gradual development of an attack;
• usually longer duration of attacks;
• psychogenic seizures are characterized by trembling rather than clonic movement;
• movements are not synchronized – each limb moves in its own rhythm;
• attacks resume after a short rest;
• the patient moves the pelvis back and forth, as during intercourse;
• turning the head from side to side;
• strong compression of the eyelids;
• psychogenic seizures occur only in the waking state.

According to Professor Uri Kramer, the manifestation of seizures changes with age and the development of the patient’s intellectual abilities. More intelligent children, after seeing epileptic seizures somewhere, are able to imitate them with high accuracy. Even if this attack is not an imitation, but a subconscious physical reaction of the body, the attack is clinically manifested as an epileptic attack. In addition, psychogenic non-epileptic seizures occur when there are spectators.

How to confirm the diagnosis?

In order to determine the diagnosis, it is necessary to make a long-term video-EEG monitoring, due to which the seizure can be registered and it can be proved that there is no epileptic activity during the seizure.

Conclusion

It is important to note that approximately 25% of patients with PNEP have concurrent true epileptic seizures. If, in the case of PNEP, an incorrect diagnosis is made (diagnosed with epilepsy), such a patient may take antiepileptic drugs for many years, which in fact was not necessary. In addition, the child or adults are not receiving the treatment they really need, namely psychiatric therapy.

If there is a suspicion that this is a combination of non-epileptic psychogenic seizures and true epileptic seizures, it is necessary to determine which seizures are real and prescribe appropriate treatment.

Important information for parents

A child, teenager or young person often has no control over these seizures, and therefore cannot be considered a feigner. We are talking about a real disease, but not associated with epileptic activity in the brain.

If PNEP continues, the child or adolescent will have difficulties in life – social life will suffer, it will be difficult to find a job or a partner.

It is important to note that there is a statistical association with PNEP and the sexual abuse experienced by the patient, as well as additional factors related to family and society. For example, a 14-year-old teenager whose mother entered into a relationship with a new man. A young perfectionist girl with many hobbies and a busy schedule, subject to constant stress.

It is important to understand the real cause of the disease, support the patient and treat these attacks with understanding. It is required to explain that you understand that attacks occur uncontrollably, and also to explain the need for psychiatric treatment.