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Psychogenic Non-Epileptic Seizures (not “pseudoseizures”)

If you’ve played in the emotional and mental health arena for any length of time, you’ve likely heard the term, pseudoseizure. Interesting stuff, to say the least. Let’s learn, okay?

Before we go any further, let’s set the record straight. The term, pseudoseizure, is old-school. Correct is, psychogenic non-epileptic seizure (PNES).

And while we’re at it, let’s do some defining. A seizure occurs when the electrical firing of nerve cells is up to four times greater than the norm. Epilepsy is a pattern of repeated seizures. Epileptic simply refers to anything having to do with epilepsy.

A PNES, on surface, resembles an epileptic seizure; however, the errant electrical firing we just discussed isn’t happening. But let’s be clear, someone experiencing a PNES is absolutely not “faking-it.” There’s no pretense involved.

Fascinatingly enough, 10-30% of PNES patients also have epilepsy.

So how might a medical professional differentiate a PNES from an epileptic seizure? The surest thing is something known as, long term video-EEG (electroencephalogram). Simply, the goal is to have an episode or two captured simultaneously on the EEG and the video. It’s then the tale can be told.

There are other differentiating factors. More common to a PNES is biting the tip of the tongue, seizures lasting more than two minutes, seizures having a gradual onset, the eyes being closed during a seizure, and side-to-side head movements.

Manifestations uncommon in a PNES are automatisms (automatic complex movements during the seizure), severe tongue biting, biting the inside of the mouth, and incontinence.

Finally, upon examination, PNES patients tend to resist having their eyes forced open. They’ll also stop their hands from hitting their face if a hand is dropped over the head; and they’ll fixate their eyes in a manner that suggests errant nerve firing isn’t an issue.

It’s known that some 75% of PNES patients are women. The typical age of onset is the late-teens to early-20s. It’s not unusual for PNES patients to have a history of multiple unexplained medical problems. And a history of emotional and mental health disorders, such as major depressive disorder or an anxiety disorder, is common. Comorbid personality disorders are not unusual.

So what’s the cause of PNES syndrome? Good question, ’cause no one really knows for sure. Since there’s often a personality disorder present, childhood trauma is frequently brought into the mix. So it’s a matter of an expression of repressed psychological harm in response to trauma such as child abuse. Interestingly, when motor involvement is a characteristic of the PNES, the abuse was typically perpetrated by the father.

Other possible causes are bullying in adulthood, learning disabilities, and dysfunctional family dynamics.

How is PNES syndrome treated? First of all, after diagnosis, a very delicate conversation has to take place between the care provider and patient. For someone emotionally fragile, hearing his/her seizures are, in effect, “in their head” may be a bit tough to handle. When the situation is stable, it’s a matter of openly and frankly explaining what’s likely going on.

Common psychotherapies employed are cognitive behavioral and insight-oriented. Group work is frequently used. Of course, any comorbid diagnoses (major depressive disorder, panic disorder, etc.) are treated simultaneously. Antidepressants, in some cases, have been found to be helpful.

But I have to shoot straight with you – lasting positive outcomes are tough to achieve.

So there you have it, a quick bit of learning featuring psychogenic non-epileptic seizures. I love researching and presenting this stuff. Can you tell?