What is a pseudoseizure?

Pseudoseizures, also referred to as psychogenic nonepileptic seizures (PNES), are seizures arising from psychological causes, such as severe mental stress.

Treatment of the underlying psychological cause may also help to reduce or eliminate the number of seizures that occur.

Because the symptoms are very similar to those of epilepsy, misdiagnosing the condition is easy, but that will result in the wrong treatment approach.

Learn more about the causes and effects of pseudoseizures, and treatment options in this article.

What is a pseudoseizure?

Blue colored human brain
Pseudoseizures are caused by psychological stress.

A pseudoseizure is a type of nonepileptic seizure that results not from brain activity but from psychological conditions.

There are many types of seizures which can range from mild to medical emergency in severity. They fall into two groups of generalisation: epileptic and nonepileptic.

Doctors can diagnose someone who has epileptic seizures as having epilepsy, a disorder which causes frequent seizure outbreaks.

Nonepileptic seizures are seizures which occur in someone without epilepsy.

Pseudoseizures are common according to the Epilepsy Foundation. Research shows that around 20 per cent of people attending electroencephalogram (EEG) monitoring epilepsy centers have pseudoseizures rather than epileptic seizures.

Symptoms

While pseudoseizures are distinct from epileptic seizures, they have similar symptoms. Symptoms can involve a pseudoseizure:

  • involuntary muscle stiffening, convulsing, and jerking
  • loss of attention
  • loss of consciousness
  • confusion
  • falling down
  • rigidity
  • staring blankly
  • lack of awareness of surroundings

As pseudoseizures are often the result of other conditions in mental health, many people may also have symptoms linked to the underlying disease.

Causes

Pseudoseizures tend to arise from mental health problems and may also occur because of severe psychological stress. The stress can be due to a single traumatic event, or to an underlying chronic condition.

Conditions or disorders that could cause pseudoseizures include:

  • anxiety or generalized anxiety disorder (GAD)
  • panic attacks
  • obsessive-compulsive disorder (OCD)
  • attention deficit hyperactivity disorder (ADHD)
  • substance abuse
  • traumatic injuries
  • ongoing family conflict
  • anger repression or anger management issues
  • emotional disturbance
  • physical or sexual abuse
  • post-traumatic stress disorder (PTSD)
  • dissociative disorders
  • schizophrenia

Pseudoseizures and their underlying causes can seriously affect the quality of life, so it is essential that people are diagnosed and treated properly.

Diagnosis

An EEG may be performed to diagnose pseudoseizures accurately.
An EEG may be performed to diagnose pseudoseizures accurately.

Pseudoseizures can be difficult to diagnose. It is rare for a doctor to experience a seizure and the symptoms the individual describes will also match those of an epileptic seizure.

In certain cases, a doctor may diagnose a person with epilepsy wrongly and then find pseudoseizures until the person is not responding to epilepsy medications.

Anyone who regularly has seizures that do not respond to medication for epilepsy that need to stay in a specialty care unit to monitor video-EEGs.

An EEG records and monitors the brain activity of a person on video, so that physicians have all the details they need to identify the disorder while they are having a seizure.

If the EEG shows no abnormal neuron firing in the brain, then the person may have PNES rather than epilepsy. The doctors will also watch the seizure video to seek out any physical clues.

A team of psychologists, physicians, and neurologists often are expected to work together to diagnose and treat PNES.

Specialists may help to recognise any psychological stress or symptoms that could cause the pseudoseizures.

Treatment

Pseudoseizure therapy differs widely and will also concentrate on treating the effects of any mental health disorder or other stressors.

Some therapies that may be useful in treating PNES usually include:

  • individual or family counseling
  • cognitive behavioral therapy (CBT)
  • relaxation techniques
  • behavioral therapy
  • eye movement desensitization and reprocessing (EMDR) therapy, for traumatic memories
  • antidepressants
  • medications for underlying psychological issues

A doctor may usually perform a structured assessment to help identify the root of the pain, illness or stress. They will then prescribe alternative treatment or therapy for the underlying disorder.

A crucial aspect of recovery is to meet with a psychologist, psychiatrist, or other approved therapist. Therapy may help people recognise the pain or stresses that affect them, and develop new methods of coping.

Prevention

There is no direct way to stop the occurrence of pseudoseizures, but taking steps to treat any underlying mental health conditions may help prevent them.

Anyone who has been dealing with trauma from the past should consider taking counseling or therapy to develop positive approaches to the issue. This may involve relaxation practices, exercises of thought, or other therapies.

Outlook

Anyone who has seizures but does not respond to drugs for epilepsy should speak to a doctor. Such symptoms may be due to pseudoseizures, which need a radically different approach to treatment.

Pseudoseizures do not have a clear remedy, but treating some underlying psychological problems will help common symptoms. Psychotherapy, medications, or counseling may help people cope with any pain and tension that may cause the pseudoseizures.

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