What is a Pseudoseizure?

What is a pseudoseizure? A pseudoseizure is the name for the condition now known as a psychogenic non-epileptic seizure (PNES). Pseudoseizures resemble epileptic seizures, but are regarded as a psychological condition rather than a physical one, although many patients are wrongly diagnosed as having epilepsy. So what is a pseudosizure and what differentiates it from an epileptic seizure?

Pseudoseizures can be distinguished from epileptic seizures by use of ECG monitoring, although other diagnostic criteria will be required to ensure a correct diagnosis. Patients experiencing a pseudoseizure do not produce the same electrical brain discharges seen during epileptic seizures, although as many as 30% of epileptics also suffer from PNES. The DSM-IV classifies pseudoseizures as a somatoform disorder

What causes pseudo seizures?

Pseudoseizures tend to occur during periods of extreme stress and are more commonly seen in women, particularly those who have been subjected to childhood abuse—some experts believe that the seizures are the psychological manifestation of repressed trauma. Patients with a history of mental illness and who have already been diagnosed with a dissociative or anxiety disorder are also more at risk of suffering from psychogenic non-epileptic seizures.

The seizures usually begin in the late teens, but PNES can also be diagnosed in younger children and elderly patients. When the seizures are seen in younger children, other parasomnias may also be present, including night terrors and other sleep disturbances.

What are the characteristics of a pseudosizure?

Psychogenic non-epileptic seizure disorder is a conversion disorder. The patient displays the symptoms of a seizure during periods of stress and hysteria, but unlike an epileptic seizure, the patient is still aware of their surroundings and will probably close their eyes. Pseudoseizures are usually longer lasting than an epileptic seizure and remain intense throughout the entire episode.

What is a pseudoseizure and how is it diagnosed?

The symptoms of seizures can occur for a number of different reasons, most typically because of epilepsy, which can make it very difficult for the patient to receive the correct diagnosis. Video footage of the seizure, used in conjunction with an electroencephalogram reading, can help to rule out the possibility of epilepsy as the root cause.

In some cases, a patient’s history can help the clinician make a firm diagnosis, but in other cases, there will be further clues to suggest that the cause of the seizures is psychogenic rather than epilepsy. If certain events, for example stress or pain, trigger a seizure, this is normally indicative of psychogenic non-epileptic seizures, but a resistance to drugs typically used to treat epilepsy is also indicative of psychogenic seizures. Pseudoseizures are also more likely to be exacerbated by the presence of an audience during the attack, which suggests a greater awareness of the event.

How is non-epileptic attack disorder treated?

Drugs used to treat epileptic seizures have very little effect on non-epileptic seizures, although they can be helpful if the patient is suffering from a combination of the two disorders. Once the patient has been correctly diagnosed with non-epileptic seizure disorder, psychotherapy can be an effective treatment, although any underlying conditions such depression will also need to be treated with appropriate medication.

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