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Psychogenic Non-Epileptic
Seizures

Psychogenic non-epileptic seizures (PNES) are a type of non-epileptic seizure. They are caused by psychological trauma or other mental health conditions. They can be difficult to diagnose and very frustrating for a patient and their doctor.

Symptoms

The symptoms of PNES are like those of epileptic seizures. They can include:

  • Falling to the ground
  • Shaking uncontrollably
  • Jerky movements
  • An unfocused stare

Some types of symptoms are more common in PNES than in epileptic seizures, such as:

  • Closing the eyes during the seizure
  • Shaking the head side to side
  • Clenching the mouth
  • Shouting verbal phrases
  • A startle response in the middle of a seizure
  • Stuttering during the event

Causes & Risk Factors

Psychogenic non-epileptic seizures are considered the body’s reaction to a traumatic psychological event. The patient is not aware of what is occurring during the seizure and most importantly, is not faking their symptoms.

Patients who develop PNES are most likely to have experienced or witnessed:

  • Physical abuse
  • Sexual abuse
  • Extreme violence

Sometimes the traumatic event has been repressed. In these cases, psychological therapy can help uncover it. However, there are times that the traumatic event is never discovered.

Psychogenic non-epileptic seizures are more common in:

  • Women
  • Young adults
  • Healthcare workers

PNES often exists along with other mental health conditions, such as:

  • Depression
  • Anxiety
  • Post-traumatic stress disorder (PTSD)
  • Personality disorders

Diagnosis

Diagnosing PNES can be challenging. It may take a long time. This is because other causes must first be excluded.

The doctor may request these tests to help:

  • Electroencephalogram (EEG) – this is a test where electrodes are attached to the patient’s scalp to measure brain activity. If the EEG shows abnormal brain activity during seizure symptoms, the diagnosis is epilepsy. If the EEG shows normal brain activity during a seizure, the diagnosis is non-epileptic seizures.
  • ECG – a heart tracing. This helps the medical team see if heart problems are causing the symptoms.
  • Echocardiogram – a heart imaging study which watches the heart as it works.
  • Bloods tests – looking for electrolyte, thyroid, or metabolic problems that may be causing the symptoms
  • Video-EEG monitoring – a test that is only done in special seizure units in the hospital. The patient stays overnight at the hospital for up to two weeks. During the stay, the patient in monitored via EEG and constant video feed. This allows the doctor to observe a patient’s seizure via video and via EEG.
  • Home videos from family members or friends – videos of the patient having a seizure taken by a family or friend can be very helpful in making the diagnosis

Treatment

Traditional anti-epileptic medications do not work for PNES. However, medicines for co-existing mental health conditions, such as anxiety or depression, are sometimes helpful.

The main treatment for PNES is psychological therapy. It is important that this is performed by a qualified mental health practitioner. The therapy usually consists of talk therapy, where the patient will be encouraged to work through any traumatic events in a supportive environment.

PNES is often a difficult diagnosis for patients, family and friends to accept. This is partly due to the societal stigma attached to mental health disorders. However, it is important to note that the seizures because of PNES are real responses to real psychological stressors. Studies have shown that if a patient is able to accept their diagnosis, symptoms will often improve. Family and friends play a crucial role in supporting the patient in this.

 
 
 

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