Nonepileptic Seizures

Nonepileptic seizures are episodes that briefly change a person’s behavior and often look like epileptic seizures. The person having nonepileptic seizures may have internal sensations that resemble those felt during an epileptic seizure. The difference in these two kinds of episodes is often hard to recognize by just watching the event, even by trained medical personnel. But there is an important difference. Epileptic seizures are caused by abnormal electrical changes in the brain and, in particular, in its outer layer, called the cortex. Nonepileptic seizures are not caused by electrical disruptions in the brain.

I know there are many different kinds of seizures. Are there different types of nonepileptic seizures too? What causes them?

Yes. Nonepileptic seizures are classified into two major groups: physiologic and psychogenic.

Physiologic nonepileptic seizures are caused by a variety of conditions that can be the result of sudden changes in the blood supply to the brain or in the sugar or oxygen levels in the brain. These include changes in heart rhythm (cardiac arrhythmia), sudden drops in blood pressure (syncopal episodes), or very low blood sugar (hypoglycemia). Other physical conditions, such as sleep disorders and movement disorders, may have symptoms or episodes associated with them that can look like seizures. It is important to get these sorted out by a physician.

Psychogenic nonepileptic seizures seem to be caused by stressful psychological experiences or emotional trauma. Psychogenic nonepileptic seizures are one way that the body indicates excessive stress.

Do you mean that people having psychogenic nonepileptic seizures are faking?

No. It is very important to recognize that these seizures are real events, although they are different from epileptic seizures. In the past, they were sometimes called “pseudoseizures” or “hysterical seizures” and people having them were thought to be making them up or trying to get attention. We now know there is nothing false or insincere about these seizures, and it is important to diagnose them correctly so that people who have nonepileptic seizures can get appropriate treatment.

What kind of stress can result in people having nonepileptic seizures?

That varies with each individual. For some people it may result from sexual or physical abuse, either recent or in the past, especially in their childhood. Others may have experienced a major life event such as a divorce or the death of someone close to them.

Why is it important to diagnose nonepileptic seizures?

As with any disorder, it is important to diagnose it correctly so that the appropriate treatment can be offered. If the episodes are caused by a physical condition, the underlying cause, such as a heart problem, needs to be identified and treated.

If they are caused by emotional trauma or other types of stress and they look like epileptic seizures, people may be diagnosed with epilepsy and started on antiepileptic drugs (AEDs), which is not the appropriate treatment for nonepileptic seizures. Adjustments in lifestyle are likely to be different for a person with nonepileptic seizures than for a person with epilepsy.

Can a person have both epileptic seizures and nonepileptic seizures?

Yes. This is one reason it is often hard for doctors to diagnose nonepileptic seizures, since they may look similar to those that are caused by epilepsy. Some studies have shown that up to 20 percent of the people who are evaluated at adult epilepsy centers have nonepileptic seizures. Some of these patients will have both kinds of episodes.

How do doctors diagnose nonepileptic seizures?

As with all seizures, it is important to have descriptions by those who observe them, such as family or friends. Specialized monitoring with an electroencephalogram (also called EEG or brainwave test) during an actual seizure is the most accurate way to diagnose nonepileptic seizures. This test records the brain rhythms of the person for a prolonged period, usually one or more days, while video images of the person are recorded at the same time. Hopefully, several events can be recorded, both on the EEG and on video, so that family or other observers can agree that these are the same kind of episodes they have seen.

Sometimes, it may be necessary for the doctor to take the patient off AEDs. Patients may be asked to carry out activities that seem likely to bring on a seizure such as staying up all night. Certain blood tests may help to determine whether the episode is epileptic or nonepileptic.

If nonepileptic seizures are diagnosed, an evaluation by a psychologist or psychiatrist is usually the next step to help sort through any stress or trauma that may be the underlying cause of nonepileptic seizures.

Is it always necessary to be in the hospital for this testing?

No. Diagnostic testing can be done as an outpatient, using EEG monitoring equipment that can be worn, if the person has frequent episodes (every one or two days) and can be closely watched by someone who can write down information about the seizures on a log sheet. However, in most cases, it is probably more reliable to do the monitoring in a hospital setting with simultaneous video recording, and a team of health care professionals to help sort out the events, and decide with the patient the best treatment.

What is the treatment for nonepileptic seizures?

Treatment begins with a careful discussion of the results of the EEG and video monitoring. Unless the person has other seizures that are epileptic, AEDs will not be necessary.

Supportive professional counseling can be provided to identify and treat the underlying stress or trauma. If depression or anxiety is a part of the cause of the nonepileptic seizures, medications may be used to eliminate these symptoms. The goal is to eliminate these episodes and restore the person to a satisfactory level of everyday activity. The outcome of treatment is usually better than that for individuals with epileptic seizures, especially when the episodes have only recently started.