Psychogenic Nonepileptic Seizures

Definition

Psychogenic nonepileptic seizures (PNES) are seizure-like movements, sensations, or behaviors. Though PNES may appear similar to epileptic seizures, they have very different causes.

Causes

Most seizures are caused by problems with electrical signals in the brain or brain injury.

However, PNES are not caused by these types of problems. The symptoms are actually caused by psychological factors such as intense emotions, traumatic experiences, or stress. Other psychological conditions such as depression are also present.

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Risk Factors

Factors that may increase the risk of PNES include:

• History of physical trauma, especially sexual trauma
• A recent traumatic event, such as a divorce or the death of a loved one
• Family history of epilepsy

• Risk factors specific to children include:
• Difficulties in school
• Family conflict
• Interpersonal conflicts, such as bullying

Symptoms

PNES symptoms may include:

• Loss of consciousness
• Staring
• Shaking, uncontrollable muscle movement, and falling

PNES may differ from epilepsy in that PNES symptoms do not usually include:

• Loss of bladder or bowel control
• Confusion, headache, and fatigue that occurs after an epileptic seizure
• Eyes that remain open
• Inability to speak

Diagnosis

You will be asked about your symptoms and medical and mental health history. The doctor will ask questions about the seizure such as what happens during them, how long they last, and how you feel after. A physical exam will be done. You may be referred to a doctor that specializes in the nervous system and the brain.

Blood tests and brain scans may be done to look for potential causes of seizures, if the cause is not clear.

An EEG is a test that shows the electrical activity in the brain. This test can help identify electrical problems in the brain associated with seizures. An EEG is most effective when done while video monitoring. If a seizure is seen on video but there is no change in EEG, PNES is diagnosed.

Treatment

Managing underlying psychological issues will stop seizures.

Medications will not help in managing pseudoseizures. However, you may be given medications to treat underlying conditions or mental health conditions.

Mental health therapy is designed to help cope with stressors, change thought patterns, and learn new behaviors. You will be referred to a mental health therapist for evaluation and treatment. Types of therapy may include psychotherapy, cognitive-behavioral therapy, and group therapy.

Prevention

There is no known ways to prevent PNES.