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Psychogenic Nonepileptic Seizures Explained

Posted on February 25, 2021
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Brooke Dulka, Ph.D.

People living with epilepsy are likely well familiar with epileptic seizures, episodes of uncontrolled movements, sensations, and behaviors. However, there is a second type of seizure you should know about if you’ve been diagnosed with epilepsy: psychogenic nonepileptic seizure (PNES). Though the two types of seizures appear similar, PNES does not start in the brain. Rather, psychogenic seizures are thought to be somatic (bodily) manifestations of psychological stress.

About 75 percent of people who experience psychogenic nonepileptic seizures are women. These seizures most frequently start during late adolescence or early adulthood. Notably, it’s possible for a person with epilepsy to experience both epileptic and nonepileptic seizures. However, according to Yale Medicine, a study found that 10 percent of people had been misdiagnosed with epilepsy when, in fact, their seizures were nonepileptic.

“I have epilepsy as well as [PNES],” wrote one member of the MyEpilepsyTeam. “I have to get examined by a doctor every four years to keep my driving license.”

Like an epileptic seizure, PNES can be very stressful. Stress can also trigger seizures. Having the right knowledge is key to reducing stress and managing the disorder.

Symptoms of Psychogenic Seizures

Psychogenic nonepileptic seizures resemble typical epileptic seizures, also known as tonic-clonic seizures. Characteristics or symptoms of a psychogenic seizure can be both behavioral and physical:

  • Auras — A warning sign that a seizure is coming, auras may include strange feelings, dizziness, hot flashes, sweating, strange tastes or smells, sounds, visual disturbances, nausea, heart palpitations, and headaches.
  • Movement (motor) symptoms — These can include intense shaking movements of the arms, legs, or head — or even complete paralysis.
  • Changes in awareness — Awareness or consciousness can change during a psychogenic seizure. Some people report going blank, being absent, or feeling out of body during a psychogenic seizure.
  • Vocal sounds and symptoms Sounds made during a psychogenic seizure might include cries, screams, growls, gasps, and shouts. On the other hand, some people are completely mute during a seizure.
  • Injuries and other behaviors — People can unintentionally hurt themselves during a psychogenic seizure, such as biting their tongue or falling. Some people also may lose control of their bladder during a seizure.

Psychogenic Seizures and Epilepsy

Psychogenic seizures are a type of conversion disorder, which essentially means that symptoms can’t be explained by a pure medical evaluation. Psychogenic seizures can also be mistaken for epilepsy because the symptoms are so similar

Electroencephalogram (EEG) recordings reveal, however, that those experiencing a PNES do not display the typical EEG brain activity. That’s because psychogenic seizures don’t begin in the brain. They’re a physical manifestation of psychological distress.

That said, psychogenic seizures can occur alongside epilepsy. One research study found that 32 percent of participants who experienced psychogenic nonepileptic seizures also had coexisting epilepsy, as determined by video-EEG monitoring procedures.

According to other scientific research, if a person has been diagnosed with epilepsy and psychogenic nonepileptic seizures, the PNES episodes almost always preceded the presence of epileptic seizures. Many times, a diagnosis of psychogenic nonepileptic seizures comes after a person has gone to an epilepsy center.

Causes and Risk Factors of Psychogenic Seizures

One of the biggest risk factors for psychogenic nonepileptic seizures is a preexisting mental health disorder or trauma. Common psychiatric conditions that can precede psychogenic nonepileptic seizures include:

  • Depression
  • Post-traumatic stress disorder
  • Dissociative disorders
  • Borderline personality disorder

Researchers have discovered other risk factors for psychogenic nonepileptic seizures. A history of sexual or physical abuse, for example, commonly precedes the onset of psychogenic nonepileptic seizures. One study found that this was particularly true when trauma occurred during childhood or adolescence.

Female sex, poor visual memory, problems with neuropsychological performance, and low IQ have also been associated with an increased risk of psychogenic nonepileptic seizures. Another small study observed that a family history of epilepsy and acute traumas, such as head injuries, often preceded the onset of psychogenic nonepileptic seizures.

Dangers of Psychogenic Seizures

Like most seizure types, psychogenic episodes can be dangerous. Injury can easily occur during a seizure. Psychogenic nonepileptic seizures can also heighten symptoms of a preexisting mental health condition, such as anxiety.

Psychogenic Seizure Treatment Options

Psychogenic nonepileptic seizures are considered by some to be just as disabling as epilepsy; however, they are not adequately addressed or treated by clinicians. The common comorbidity between psychiatric illness and psychogenic nonepileptic seizures also makes treatment extremely difficult.

Although seeing a neurologist is important when first seeking treatment, care will primarily come through a mental health setting.

Psychological Counseling

One comprehensive clinical trial demonstrated the importance of behavioral therapies, either on their own or in combination with an antidepressant. Study participants who attended psychotherapy (specifically cognitive behavioral therapy, or CBT) had a 51 percent seizure reduction and significant improvement in depression, anxiety, quality of life, and global functioning.

Medication

Those who combined CBT and the antidepressant drug Zoloft (sertraline) showed 59 percent seizure reduction, as well as improvements in global functioning. The sertraline-only group, on the other hand, did not show a reduction in seizures.

Psychogenic nonepileptic seizures are a psychiatric disease that should be treated by a team that includes a psychiatrist (for medication management) and a psychologist (for behavioral treatment). When first beginning treatment, a neurologist may recommend an antiepileptic drug. That said, follow-up care with a mental health professional is strongly recommended to best treat and manage the condition.

Living with Psychogenic Nonepileptic Seizures

Although psychogenic nonepileptic seizures are challenging, there are ways to keep them in check.

Meditation

Practicing mindfulness — a form of meditation that focuses on observing the present moment — has proven to be a simple and effective lifestyle change. One study found that after 12 sessions of mindfulness-based therapy, seizure frequency, intensity, and quality of life improved. Mindfulness can even be practiced as a form of prayer.

Identify and Avoid Triggers

If you or a loved one suffers from PNES, it’s important to be aware of seizure warning signs and triggers. Reduce stress as much as possible by getting adequate sleep, nutrition, and exercise.

Also, avoid trauma cues. A trauma cue is anything associated with a previous traumatic event. For example, if a person was in a car accident, vehicles can serve as reminders of the experience. This reminder can cause stress, which can trigger seizures.

Cell phone apps and websites can help you track seizures and triggers. By identifying triggers, you can help yourself or your loved one make strides toward healthier, safer living today.

You Are Not Alone With Psychogenic Seizures

When you join MyEpilepsyTeam, you gain a social support network of more than 92,000 people who understand what it’s like to live with seizures, including psychogenic seizures.

Do you experience psychogenic seizures? Have you found ways to manage them? Comment below or post on MyEpilepsyTeam.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.

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