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Epilepsy vs. Psychogenic Nonepileptic Attacks

Updated on September 13, 2021
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Torrey Kim

If you find that stress tends to trigger your seizure activity, you’re not alone. Members of MyEpilepsyTeam often talk about stress and its impact on their health. However, stress-related attacks that appear to mimic seizures may actually be psychogenic nonepileptic attacks (PNEAs), which are different from epilepsy. Although a PNEA technically isn’t a seizure, it is commonly referred to as a “psychogenic nonepileptic seizure (PNES).”

How Are Epileptic Seizures Different From PNEAs?

Epilepsy is a neurological disorder. A person is diagnosed with epilepsy after having two unprovoked seizures that are associated with abnormal electrical activity in the brain.

A psychogenic nonepileptic attack is a functional disorder that is diagnosed after a person has episodes that may look like epileptic seizures, but in fact, are not. These attacks are not associated with abnormal electrical activity in the brain. PNEAs are provoked by underlying psychological distress. However, many people still label them as seizures.

Some people have a combination of both conditions, and it is important to identify and characterize what you have because the treatment is vastly different.

“I have epilepsy and … I also have nonepileptic seizures,” one MyEpilepsyTeam member wrote. Another said, “I found out I have both generalized epilepsy and psychogenic nonepileptic events.”

Understanding PNEA

Whether brought on by a major life event or a buildup of everyday challenges, stress affects each person differently. For some, stress can lead to a PNEA, which may be misdiagnosed as an epileptic seizure. In fact, a Johns Hopkins Hospital team observed that more than 30 percent of people admitted to the hospital’s epilepsy unit for intractable seizures were actually experiencing psychogenic nonepileptic attacks and not epilepsy.

One key to distinguishing between PNEA and epilepsy, the Johns Hopkins team noted, was that antiseizure medications were not effective in curbing PNEA seizure-like symptoms. These drugs typically work when treating those with epilepsy.

Researchers have noted that in some cases, emotional stimuli can trigger epileptic seizures. Therefore, a health care team must be very detailed when evaluating people who experience symptoms so they can carefully differentiate between epilepsy and a PNEA.

If your physician suspects you may have PNEA, they may order electroencephalogram (EEG) video monitoring. This process entails monitoring a person for a set period of time via video, observing their seizure or attack activity while also analyzing their brain’s electrical activity.

This can be helpful in allowing physicians to definitively identify whether someone has epilepsy or PNEA.

Managing Stress

Whether you have PNEA or epilepsy, reducing the stress in your life can be helpful. According to the Epilepsy Foundation, 9 out of 10 people who actively manage their stress believe it has cut their risk of seizures.

If your health care team finds that you have PNEA and not epilepsy, your treatment is likely to involve a multidisciplinary team such as a psychologist, neurologist, primary care provider, and possibly a psychiatrist and mental health counselor.

The goal will be to reduce the stressors in your life that trigger the attacks. As part of that stress-reduction strategy, you’ll also want to consider eating a healthy diet, making sure your physical health is strong, and incorporating exercise into your routine.

If you instead have epilepsy, your health care team will make a determination of which treatments will work best for you. This may include medications such as antiepileptic drugs, implanted devices, dietary changes, surgery, or a combination of these treatments — in addition to reducing your stress.

Curbing your stress can not only help clear your mind; it can allow you to get out of a loop in which you are stressed about actually having a seizure. “My main stress is worrying about having a seizure,” one MyEpilepsyTeam member said.

Although stress is a part of everyone’s life, managing its impact on you could help reduce your seizures or attacks in the future.

Talk With Others Who Understand

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. On MyEpilepsyTeam, more than 97,000 members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

How does stress impact your life? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Torrey Kim is the managing editor at MyHealthTeams and has over a decade of experience writing about medical conditions. Learn more about her here.

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