Dissociative Seizures

Introduction

Psychogenic Non-Epileptiform Seizures is a real disease. These events probably represent a subconscious dissociative physical response to distressing internal emotional stimuli. These attacks may look like epileptic seizures but are not truly caused by altered electrical activity in the brain but happen due to a reaction to adverse life experiences, trauma, loss or bereavement. Patients with PNES do not have a focal lesion, but rather have dysfunction that is distributed across a wide array of limbic and cortical substrates modulated by several key endocrine signals. The production of seizure-like symptoms is not under voluntary control, meaning that the person is not faking. Interestingly, about 5-20% of people with PNES also have epilepsy.

Other Terminologies

• Pseudoseizures - Use of this particular terminology is discouraged
• Functional Seizures
• Dissociative Seizures
• Non-Epileptiform Attack Disorder 

No single historical feature or combination of features is diagnostic of PNES. PNES are distinct from Epileptiform seizures as they do not show any abnormal electric discharge from the brain. The definitive test to diagnose PNES is Video EEG. Features that may suggest PNES are:

• Same frequency but variable amplitude throughout the seizure
• Recall of events
• Pelvic thursting
• Forced eye closure
• Episodes >2min

Treatment of PNES

1. Adequate communication and education with the patient/family
2. Continued neurological follow-up to safely withdraw anticonvulsant medications
3. Address comorbid psychiatric diagnoses - CBT/Antidepressants/Antipsychotics (Haloperidol/Olanzapine)

Further Reading
https://www.epilepsy.com/article/2014/3/truth-about-psychogenic-nonepileptic-seizures

Posted by:

              

     Lakshay Chanana

     

     ST4 Trainee

     Royal Infirmary of Edinburgh

     Department of Emergency Medicine

     Edinburgh

     Scotland

     @EMDidactic