What are psychogenic nonepileptic seizures?

  • April 6, 2022
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Epilepsy is the main reason people have seizures. However, there are several other things that can cause people to have seizure-like symptoms, including psychogenic nonepileptic seizures (PNES). These events are sometimes called pseudo seizures, but this name has been changed because it implies that people having them are intentionally ‘faking’ their experiences. In fact, PNES is very real.

Here is what you need to know about psychogenic nonepileptic seizures.

What are psychogenic nonepileptic seizures?

A psychogenic nonepileptic seizure happens when a person’s emotional stress causes them to have seizure-like symptoms. Unlike epilepsy, where unusual discharges of electricity in the brain cause seizures, PNES is usually caused by feelings of stress. They can be mistaken for epilepsy because they look similar to epileptic seizures. Psychogenic nonepileptic seizure symptoms include:

  • Losing consciousness or seeming unaware
  • Passing out or fainting
  • Trembling and shaking
  • Closing eyes and clenching teeth
  • Thrashing arms
  • Making ‘bicycling’ movements with your legs
  • Pelvic thrusting
  • Making noises

It is not clear how common PNES is, but it’s believed to affect up to 33 people per 100,000. It has also been estimated that between 5% and 20% of people diagnosed with epilepsy have PNES, or another disorder.

Recommended: The difference between epileptic and dissociative seizures

How are psychogenic nonepileptic seizures different to epilepsy?

It can be difficult for doctors to tell the difference between epileptic and non-epileptic seizures. There are some important differences, including:

  • Feelings after the seizures: After having an epileptic seizure, people normally feel confused or need to sleep - but this is less common with PNES.
  • Seizure behavior: While they may look similar at first sight, there are a number of significant differences between epileptic and non-epileptic seizures. These include the way the hands and legs move, level of awareness, whether eyes are open or closed, and the noises people make while having seizures.
  • Brain activity: An EEG machine is a useful tool for monitoring brain activity while someone is having an epileptic seizure. It will pick up on very specific brain waves that only happen if someone is having an epileptic seizure. If someone has a PNES seizure while attached to an EEG machine, these brain waves will not show up.

Related: People with PNEs might be seen at an epilepsy monitoring unit

What are psychogenic nonepileptic seizures caused by?

There are a few reasons why people develop PNES. One of the most common explanations is something called conversion disorder. This is when a person cannot express strong feelings they have inside, and so their body lets the stress out through physical movements or behaviors.

A high proportion of people who have conversion disorder have had some kind of traumatic event in their background, such as physical abuse, sexual abuse, PTSD or violence. If they are unable to express feelings about these experiences, they might develop PNES.

It’s important to be aware that some people who have epilepsy also have PNES. 

Psychogenic nonepileptic seizures treatment

Because this type of seizure is caused by psychological factors, counselling and therapy are the main treatments. This can include talking therapy, cognitive behavioural therapy, and stress/anxiety management techniques.

Being aware of psychogenic nonepileptic seizures

It is important for both doctors and patients to be aware of psychogenic nonepileptic seizures and what causes them. If someone with PNES is misdiagnosed as having epilepsy, there is a risk that they will be taking anti-epilepsy drugs unnecessarily. At the same time, the underlying cause of the seizures won’t be resolved.

If you are having seizures that don't seem to be controlled by your anti-epileptic drugs, it is important to speak to your doctor. They may choose to refer you to an epileptologist for further tests and to help address the problem. 

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