Non-epileptic seizures are also forms or known as pseudo seizures, conversion disorder, somatoform disorder, and pychogenic seizures. These seizures are attacks that look like epileptic seizures, but are not caused by abnormal electrical discharges.  Statistics say that 1 in 5 of patients sent to epilepsy centers for difficult seizures is found to have non-epileptic seizures instead of epileptic seizures.  A hint that it may be non-epileptic seizures is when seizures have unusual features such as the types of movement, duration, triggers and frequency, but they can look like generalized seizures (formerly named ‘grand-mal” seizures).  
 
Generally, a diagnosis of non-epileptic seizures is reached after a complete neurological work up is performed, thorough seizure history, seizure description, and the results of an electroencephalogram (EEG) to gauge differences in the brain’s electrical activity from what would be expected of someone prone to epileptic seizures.
One of the most common complications involved in the diagnosis and treatment of non-epileptic is the misconception that people who suffer from the phenomena are hypochondriacs, hysterics, or “faking it.” The name for the condition alone, “pseudoseizures,” leads some people to think of the occurrences as medically suspect.
   
Most importantly, it is crucial that patients and healthcare providers remember that non-epileptic seizures are seizures. There is a complete lack of control inherent in any seizure activity, and the potential ramifications of that loss of control can be just as devastating for people suffering from non-epileptic seizures as it can for those living with epileptic seizures.
 
Ideally, with the help of anti-anxiety medication and counseling, the disorder can begin to decrease its intensity. People suffering from non-epileptic seizures often have a long journey toward recovery, a journey that often includes medication, psychiatric counseling, and close medical supervision. It can be long and frustrating. However, with proper intervention, people do find themselves in full recovery from the condition.
 
Up to 20 percent of patients evaluated at adult epilepsy centers have nonepileptic seizures. Some of these patients also have epileptic seizures, which complicates the diagnosis.
 

Characteristics of Non-Epileptic Seizures 

  • Seizure-related injuries, such as broken bones, are more typical of epileptic seizures.
  • Non-epileptic seizures may begin gradually, with motor activity that slowly escalates in intensity; epileptic tonic-clonic seizures begin abruptly.
  • A cry or shriek in the middle or at the end of the seizure is suggestive of a non-epileptic seizure cause, as are motor movements that come and go, that alternately affect the left and right sides of the body.
  • Unusual posturing may occur during non-epileptic seizures; facial muscle contractions are uncommon.
  • A seizure that extends for many minutes, even an hour or longer, may be nonepileptic, especially if there is no cyanosis and the patient wakes up immediately after the seizure movements stop.
  • The recovery period (postictal state) following a nonepileptic seizure is brief; recovery from an epileptic tonic-clonic seizure lasts minutes to hours, characterized by confusion, headache, exhaustion and sleep.

My son has both epileptic seizures and non-epileptic seizures.  He is taking epilepsy medications and has a Vagal Nerve Stimulator (VNS).  As a result of this his epileptic seizures have diminished.  His non-epileptic seizures have been going on for about three years.  They happen every day and multiple times per day.  Sometimes the more severe ones occur at night, with loud yells and extreme body jerks.  Many times my son can tell when he is going to have a non-epileptic seizures and whether it is going to be a big one.  There has been a pattern indicating that stress is a major trigger of his non-epileptic seizures. Some of the characteristics of his most severe forms include punching himself in the face, choking himself, holding his breath, and kicking.   All of these symptoms then cause more stress.  My son’s non-epileptic seizures affect him every day of his life.  They occur at school, at the grocery store, at restaurants and at home.  My son’s case is really complicated.  He has been diagnosed with epilepsy, sensory processing disorder, anxiety order, non-epileptic seizures, diabetes, and Tourette Syndrome.  Sometimes it is difficult understanding what is going on.  To support this disorder, he sees a neuropsychologist every three weeks.

The most difficult thing we deal with as it relates to non-epileptic seizures is school.  His elementary school did not understand what was going on.  They didn’t know how to react, and at times accused him of “faking” the seizures.  Now he is in middle school and things seem to be better.  Our biggest issue is school absences.  With all of the doctor appointments, nights of non-epileptic seizures, and absences due to his epilepsy or diabetes, it adds up to quite a few absences from school.  Then also throw in the absences for typical childhood illness, such as the flu.  I think schools in general have a difficult time dealing with children with chronic illnesses.  Having the illnesses is hard enough without causing more stress dealing with the school on this topic.  There have been numerous times where I was forced to take my son to a doctor to get a written note explaining the absence.  The doctor could do nothing to help.  We went purely for the note.  What a wast of time and money.

REFERENCES

Alper K, Devinsky O, Perrine K, Vazquez B, Luciano D. Nonepileptic seizures and childhood sexual and physical abuse. Neurology. 1993;43:1950-1953.

Chabolla DR, Krahn LE, So EL, Rummans TA. Psychogenic nonepileptic seizures. Mayo Clin Proc. 1996;71:493-500.

Rowan AJ. Nonepileptic seizures. In: Schachter SC, Schomer DL, eds. The Comprehensive Evaluation and Treatment of Epilepsy. Academic Press;1997:173-183.

Trimble MR. Pseudoseizures. Neurol Clin. 1986;4(3):531-548.

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