Psychogenic non-epileptic seizures are a manifestation or a form of conversion disorder. They take many forms, and particularly can mimic any sort of epileptic seizure; they are distinguished from epilepsy only in that they are not associated with abnormal, rhythmic discharges of cortical neurons.
Like other somatoform disorders, they are not voluntarily produced; the patients are by definition unaware that the seizures are psychologic in origin. In this they differ from seizures produced as part of factitious disorder or malingering.
The condition is not benign; people have broken bones, crashed automobiles, bitten off parts of their tongue, and even died from injuries sustained during non-epileptic seizures.
An older term for these, pseudoseizures, should not be used. While it is correct that a non-epileptic seizure may resemble an epileptic seizure, pseudo can also connote "false, fraudulent, or pretending to be something that it is not." Non-epileptic seizures are not false, fraudulent, or produced under any sort of pretense. They are as real as any other sort of seizure; they are simply not produced by epilepsy.
Confounding neurologists and other physicians, psychogenic non-epileptic seizures are frequently misdiagnosed as epilepsy; less frequently, the reverse is true. Misdiagnosis means that appropriate treatments are not received by the patient. In addition, the former misdiagnosis is dangerous because it can result in administration of unnecessary medication; the latter because a person with epilepsy is not correctly treated with medication that could help them. Statistics on the prevalence of these misdiagnoses are not available.
Inpatient hospitalization for long term video-EEG monitoring is a costly, and effective way to distinguish them from epileptic seizures. They tend not to respond to anticonvulsant medications, but this is less useful as a diagnostic feature. Also, many persons with epilepsy experience non-epileptic seizures as well; finding evidence of one does not rule out the presence of the other.
Many physicians measure serum prolactin levels in patients who may have non-epileptic seizures, because serum levels of prolactin are often elevated just following an epileptic seizure, returning to normal within 15 minutes. Still, a negative prolactin does not rule out epileptic seizures (Ahmad & Beckett 2004). Also, individuals with non-epileptic seizures may have elevated prolactin levels for other reasons, including intercurrent epilepsy and medication side effects.
The patient with psychogenic non-epileptic seizures is sometimes found to give a history of childhood physical abuse or sexual abuse or other severe emotional trauma. However, treatment based on insight-oriented techniques or exploring of abuse histories has not been found to be effective.
Instead, treatment with cognitive therapy or behavioral therapy is focused on concrete strategies to recognize the onset of the seizures and use techniques to abort them, or to interrupt the stimulus-response pathway that produces them.
Other non-epileptic seizures
Convulsive or other seizure-like activity, non-epileptic and non-psychologic in origin, can be observed in many other medical conditions, including:
- breath-holding spells of childhood
- non-epileptic myoclonus
- hyperekplexia, also called startle syndrome
- hypoglycemia (and associated neuroglycopenia)
- Ahmad S, Beckett MW. Value of serum prolactin in the management of syncope. Emerg Med J 2004;21:e3. Fulltext. PMID 14988379.
- Betts, T. "Chapter 265: Conversion Disorders." In Epilepsy, a Comprehensive Textbook, ed. Engel, J., and Pedley, T, Lippincott-Raven, Philadelphia, 1997.
- Epilepsy Foundation article about non-epileptic seizures
- Epilepsy.com article about non-epileptic seizures
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