Not all seizures are caused by epilepsy: how to recognize false epilepsy
What are pseudoseizures or PNES
There are seizures that can be confused with epilepsy, but are actually very different and are not related with this disease at all. These are called pseudoseizures or psychogenic non-epileptic seizures (PNES).
Do not let the name fool you. Just because they are called “pseudoseizures” does not mean that the person suffering from one is faking it. Pseudoseizures are very real, though they have different causes from epileptic seizures.
During pseudoseizures, brain activity is normal, whilst in epileptic fits, the electrical impulses in the brain suffer abnormal changes.
What are the symptoms of a pseudoseizure?
Although epileptic seizures and pseudoseizures are very different in terms of brain activity, they do share some external symptoms. Symptoms of pseudoseizures may include:
- Involuntary muscle stiffness, convulsing and shaking
- Loss of focus
- Loss of consciousness
- Confusion
- Falling down
- Rigidity
- Staring blankly
- Lack of awareness of surroundings
However, these are just the visible symptoms. As pseudoseizures are usually related to other conditions, inside, there can be many other symptoms that are actually causing the PNES.
What causes a pseudoseizure?
Pseudoseizures can have a number of possible causes, depending on the individual. Usually, they happen as a result of a significant mental change or psychological stress.
This study published by Ronald P. Lesser (MD with more than 48 years of experience in the psychiatric and neurological field), looks into the possible causes of pseudoseizures for the purpose of finding a suitable treatment.
The study found that PNES can be caused by reasons such as:
Stress
Stress is a physiological response when we feel physical or emotional tension. We may experience stress due to various situations or thoughts that cause our body to adjust physically, mentally and emotionally.
Stress is a normal part of life. Our bodies are designed to feel stress and respond accordingly. Sometimes, it can even be a good thing, helping us to stay alert and motivated.
However, when stress becomes constant or the person is unable to control it, it can trigger a range of diseases (both mental and physical), including pseudoseizures.
Anxiety and panic attacks
Anxiety is our body’s natural response to stress. When we are worried about something going wrong in the future (like the first day of work, an exam or appointment), we may feel scared or nervous; in other words, we feel anxious.
Anxiety is totally normal, but again, when we are unable to control it and it becomes a frequent response to everyday situations, it can lead to excessive and constant fear, which is considered an anxiety disorder.
This can give way to panic attacks, which consist of periods of intense fear or uneasiness and depending on the intensity of the anxiety and panic attacks, they can also trigger non-epileptic seizures.
Obsessive Compulsive Disorder (OCD)
Obsessive compulsive disorder or OCD, is a disease in which a person experiences uncontrollable, recurring thoughts, feelings or ideas (obsessions) that urge them to carry out repetitive behaviors and actions as a response (compulsions).
These behaviors can include the excessive tidying or cleaning, repeatedly checking the door is closed, or counting stairs, steps, people, etc.
Given their constant and repetitive nature, these behaviors can affect daily activities and social interactions and cause serious anxiety problems or stress that may develop into various diseases.
Family conflict
Family conflicts include problems between partners, parents, children or siblings. These conflicts are a normal part of family relationships, however, there are cases in which these get out of hand and become a serious problem.
These conflicts should be taken seriously, as our family environment provides the foundation for the rest of our lives, and if we cannot relax in our own home with our loved ones, it becomes extremely difficult to stay healthy.
Fights and abuse have a huge impact on all family members, even if they are just spectators, and can also greatly affect a person’s physical and mental health.
Physical or sexual abuse
Physical or sexual abuse consists of unwanted encounters or contact to cause someone intentional harm, which can range from denying someone food or water, to throwing things, hitting, using weapons or sexually assaulting someone.
This usually starts in more subtle ways, then gets out of control. Afterwards, the abuser will tend to blame the victim, ask for forgiveness or promise never to do it again. But beware. Letting this problem continue will often just make it worse.
If you have experienced physical or sexual abuse (or know someone that may be in danger) call the authorities. These situations do not just affect a person at the time, but also leave serious physical, psychological and emotional scars that could trigger PNES or even more serious diseases.
Anger management issues
Anger is another healthy, human emotion, that can be brought on when a situation feels annoying, unfair or threatening. It is also totally normal to feel angry if someone has mistreated, offended, or harmed you in some way.
Nevertheless, sometimes anger is not expressed as it should be and manifests itself in explosions of intense and aggressive rage. When such outbursts become a regular occurence in your life, it should be treated as a chronic anger management problem.
These fits of rage may begin to affect relationships, mental and physical health of that person or those around them. Anger management problems can also go on to cause non-epileptic seizures.
Affective disorders
Affective disorders are a set of psychiatric disorders or mood disorders, which can cause great internal and external discomfort.
The most common affective disorders include depression, dysthymia (persistent depressive disorder), anxiety disorder and bipolar disorder. These can be triggered by a traumatic event, grief, the consumption of drugs or alcohol, or genetic factors.
They are problems that are often not treated as seriously as they should be, but are extremely serious and can affect relationships, physical health and the daily life of the sufferer. Affective disorders are also linked to other diseases, such as PNES.
Dissociative disorders
Dissociative disorders are mental disorders that affect a person’s ability to connect their thoughts, memories and surroundings with the their actions and identity.
Dissociation is something that we all experience when we are daydreaming, when we lose ourselves in a good book or film, or temporarily forget about reality or our surroundings. But for some people, this gets worse as a result of a traumatic experience, to deal with memories that would otherwise be very painful to deal with.
In such cases, dissociative disorder can cause social problems and other mental (like amnesia) or physical disorders (like non-epileptic seizures).
Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder affects a person’s mental balance, filling them with huge amounts of stress or fear. This disorder develops after living through or experiencing events that have caused a significant emotional impact.
It’s normal to experience some difficulties following a traumatic episode in your life. What is not normal, is when this trauma gets worse over time and starts to interfere with daily life. When this happens, this is known as post-traumatic stress disorder or PTSD.
Apart from symptoms like recurring dreams, negative thoughts and sleep disorders, PTSD can also cause depression, anxiety, eating disorders, as well as pseudoseizures.
Psychosis
Psychosis is a group of mental disorders in which a person has thoughts or ideas that cause them to lose touch with reality and experience delusions and hallucinations.
Delusions are impressions and false beliefs that are the complete opposite of reality and hallucinations are sensory experiences that occur without an actual physical stimulus.
Psychosis can occur in people with bipolar disorder, schizophrenia and personality disorders. If left untreated, can make it very difficult for the person to take care of themselves and may give way to other physical complications, such as pseudoseizures.
Schizophrenia
Schizophrenia is a type of psychosis that affects the way someone thinks, feels or behaves. It is characterized as when a person disconnects from reality and can no longer tell what is real and what isn’t.
It is a very complex disease that affects a person’s thoughts, emotions and behavior, but should not be confused with multiple personality disorder (dissociative identity disorder) or bipolar disorder.
This type of psychosis can and should be treated, as without treatment it may lead to behavioral changes that could make them a danger to themselves or the people around them, or give way to other diseases like non-epileptic seizures.
Personality disorders
A personality disorder is a mental disorder in which a person behaves, feels and thinks in a way that may be harmful to their own health.
People with this disorder may have the following 3 characteristics: eccentric thoughts or behaviors; be dramatic, excessively emotive or unpredictable; feel intense anxiety or fear.
All this is accompanied by turbulent or unstable emotions that can cause significant stress and problems socializing, and can lead to other diseases like PNES.
Substance abuse
Substance abuse includes the consumption of a range of substances (both legal and illegal), including medicines, coffee, alcohol, as well as other psychoactive and hallucinogenic substances.
In certain cases, this can develop into a type of substance addiction. However, when we talk about substance abuse, we are not necessarily referring to addition. In this particular case, the person may may be able to stop taking the substance without any problems.
Non-epileptic seizures can occur when the person has suffered an overdose of the substance they consumed or as a withdrawal symptom from a substance they have become accustomed to using.
Traumatic injuries
An injury is classed as “traumatic” when it leaves serious scars because the affected tissue could support or adapt to the impact. Seizures following an injury can even occur several weeks after the event.
Usually, head injuries are the most likely to cause seizures. If the injury penetrated the skull or required brain surgery, the probability of experiencing a seizure is very high.
If, as well as the injury, the person is under severe stress or is not sleeping enough, they are more likely to suffer form a PNES.
Attention deficit hyperactivity disorder (ADHD)
Hyperactivity and attention deficit are disorders that imply the inability to concentrate or control oneself. This is most common in children and teenagers, but can also affect adults.
Adults who suffer from ADHD may have problems with time management, organization, establishing goals, etc. It can also cause problems with relationships, self-esteem and addiction.
Both adults and children with ADHD are more likely to suffer from epilepsy or non-epileptic seizures.
All of the above can cause seizures, just remember that PNES are not related to epilepsy.
In some cases, however, it is possible that a person who suffers a non-epileptic seizure can have an epileptic seizure.
Just because a person has experienced a non-epileptic seizure, this is not to say that future seizures cannot be epilepsy-related.
You may also be interested in…
What is epilepsy? Causes, treatments and more
How are non-epileptic seizures diagnosed?
Assessing a seizure can be a very complex process. At first glance, epileptic and non-epileptic seizures can look the same.
A specific exam is required, along with a collaboration between a psychologist or psychiatrist and a neurologist to be able to diagnose a pseudoseizure. In addition, the exam has to be carried out at a hospital, while the seizure occurs and everything has to be recorded on film.
When a seizure occurs, the neurologist carries out certain tests, such as an electroencephalogram (EEG), which records the electrical activity of the brain to identify whether there are any abnormalities or unusual brain function.
Remember, if any sign of uncontrolled, abnormal or exaggerated brain activity is detected, this indicates epilepsy.
On the other hand, the psychologist or psychiatrist will try to identify whether the patient has any underlying psychological conditions, or any other of the potential causes mentioned above, which could be triggering the seizure.
How to treat pseudoseizures
Treatment for pseudoseizures varies depending on the cause. In general, treatment is focused on managing the symptoms of the condition behind the seizures in that specific case.
Treatments usually include:
- Individual, couple or family therapy: helps the individual have a better understanding of themselves, their relationships with other people and their surroundings, by means of dialogue with a specialized therapist
- Cognitive behavioral therapy (CBT): based on the idea that thoughts and feelings can greatly influence behavior, certain emotions, behaviors and thoughts are identified and modified as needed
- Eye Movement Desensitization and Reprocessing (EMDR): uses bilateral stimulation by means of eye movements, sounds, changes in tone of voice and tapping to reduce anxiety related to traumatic experiences.
- Antidepressants: following a full evaluation, specific medication is prescribed by a specialized doctor to help combat symptoms of depression.
- Specific medication for mental conditions causing the pseudoseizures: following a suitable diagnosis, the doctor may prescribe specific medication depending on the type of disorder that is causing the pseudoseizures.
It is important to note that it is still unclear if medication designed specifically to treat epilepsy are suitable for treating pseudoseizures.
What we do know is that if you have been diagnosed with epilepsy and the medication you have been prescribed is not working, it is most likely that you are experiencing non-epileptic seizures.
Can you prevent pseudoseizures?
There is no definitive way to prevent pseudoseizures, but you can take measures to avoid the associated risk factors or treat the mental condition that may be causing them.
Firstly, an official diagnosis is required to identify the cause and hence proceed with the suitable treatment. As well as the guidance and therapies we mentioned earlier, these treatments treatments can also include various relaxation techniques, physical exercise, meditation, yoga, etc.
Choose a practice that works best for you. The goal is to introduce a habit into your daily routine that helps you reduce stress in your everyday life and maintain physical, mental and emotional balance.
And there you have it; what non-epileptic seizures are, why they happen and how to diagnose and treat them. Still have questions about epilepsy and the best alternative treatments?
How to help someone who is having a seizure?
If you see someone having a seizure, there are certain things you can do to help and some things you should avoid:
If I see someone having a seizure
| Stage | What should I do? | What should I NOT do? |
| While the person is having the seizure | Look after the person so that they don’t fall or hit themselves on the groundProtect or cushion their head Put the person on their sideTake off any accessories that are pulled tight around the neck, such as ties Keep calm Remove any objects that could harm the person Time the length of the seizure Look for any medical ID bracelets or accessories Stay with the person until the seizure passes | Restrict the person´s movement Put anything in the person´s mouth Give the person mouth-to-mouth Give them medication, liquids, food, etc. Panic Give the person food or drink before they have completely recovered Try to move them before they have recovered completely Leave them alone |
| After the seizure | Give them space; keepcrowds away Let the person rest Check that they are gradually returning tonormal Check if the person has injuries Clean their mouth if they are having difficulty breathing Calm the person downDecide whether or not to call emergency services | Give the person food or drink before they have completely recovered Try to move them before they have recovered completely Leave them alone |
When should I call emergency services?
- If the seizure lasts more than 5 minutes
- If they have another seizure before the person has time to recover
- If the person injured themselves during the seizure
- If the seizure happened following a blow to the head
- If the seizure happened after inhaling gas or poison
- If the person who had the seizure is pregnant
- If after the seizure the person has problems speaking or understanding, cannot see or is unable to move a part of their body
Now that you know what to do (and not do) to help someone having seizure, share this article with your loved ones, you never know when it could come in handy.
Other sources:
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https://www.cdc.gov/epilepsy/spanish/primeros-auxilios.html
https://es.wikihow.com/ayudar-a-alguien-con-una-convulsi%C3%B3n
https://my.clevelandclinic.org/health/articles/11874-stress
https://www.healthline.com/health/anxiety
https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder
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https://au.reachout.com/articles/what-is-physical-abuse
https://www.helpguide.org/articles/relationships-communication/anger-management.htm/
https://www.healthline.com/health/affective-disorders#causes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181864/
https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders
https://medlineplus.gov/spanish/ency/article/001553.htm
https://www.healthline.com/health/psychosis#outlook
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https://www.ncbi.nlm.nih.gov/pubmed/19369016