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Psychogenic Non-epileptic Seizures

Psychogenic seizures are not classified as a form of epilepsy. They affect between five and twenty per cent of people thought to have epilepsy. Psychogenic seizures can occur at any age, but are more common in people under the age of 55. They occur three times more frequently in women than men. They may arise from various psychological factors, may be prompted by stress, and may occur in response to suggestion.

 

Such disorders seldom occur in the absence of others. Trauma related to physical illness has been found to trigger these seizures in elderly individuals. People with early-onset psychogenic seizures often have a history of sexual abuse.

 

Psychogenic seizures can be characterized by features common with epilepsy like writhing and thrashing movements, quivering, screaming or talking sounds, and falling to the floor. Psychogenic attacks differ from epileptic seizures in that out-of-phase movements of the upper and lower extremities, pelvic thrusting, and side-to-side head movements are evident. However, psychogenic seizures vary from one occurrence to another and are not readily stereotyped.

 

Indicators like pupillary dilation, depressed corneal reflexes, the presence of Babinski responses, autonomic cardiorespiratory changes, tongue biting and urinary/fecal incontinence are more probable with epilepsy. These are not usually manifested in psychogenic seizures.

 

Psychogenic seizures may last a couple of minutes or hours, ending as abruptly as they began. A person may experience anxiety prior to an attack, followed by relief and relaxation afterwards. This leads some to postulate that psychogenic seizures may occur as a direct response to stress in order to relieve tension. Afterwards, patients usually have a vague recollection of the seizure, without the usual postictal symptoms of drowsiness and depression.

 

It is difficult to differentiate between psychogenic and epileptic seizures. One highly reliable indicator of a psychogenic seizure is eye closure during the seizure. When people with epilepsy have seizures, the eyes tend to remain open. Still, in 20 to 30 per cent of cases, epileptologists are incorrect in attempting to distinguish one from the other.

 

Although psychogenic seizures are not caused by electrical discharges in the brain and thus do not register any EEG abnormalities, they are often mistaken for epileptic disorders. It is also possible to have both psychogenic seizures and epilepsy. Most patients with psychogenic seizures are misdiagnosed and consequently treated with epilepsy drugs or other epilepsy therapies, sometimes with severe and fatal side effects.

 

Medications are ineffective in the treatment of psychogenic disorders. Patients who are diagnosed with psychogenic seizures are usually referred to a therapist to learn to control stress and become familiar with coping techniques. As the vast majority of psychogenic seizures operate on a psychological level, behavioural manipulation methods may be used.

 

Reprinted in part from Epilepsy Ontario.