A seizure (more commonly known as a convulsion) occurs when a person’s body shakes uncontrollably and rapidly. During an attack, your muscles repeatedly contract and relax, although mild symptoms may occur without visible shaking. These seizures are typically caused by a condition called epilepsy, wherein a physical problem in the brain causes abnormal electrical activity. On the other hand, pseudoseizures are non-epileptic convulsions that are not associated with physical brain changes or abnormal electrical activity of the brain cells. They are often thought to be psychological in nature and may be called psychogenic non-epileptic seizures (PNES) or non-epileptic attack disorders (NEAD). Compared to a true seizure, wherein a patient is unaware of the attack, a pseudoseizure is sometimes considered a false or deceitful behavior (thus they are called pseudo seizures).
What Are the Symptoms of Pseudoseizures?
Seizures are often accompanied by signs and symptoms like a brief, sudden blackout or confusion, a change in mood or behavior, muscle spasms, drooling/frothing in the mouth, eye movement, grunting, snorting, teeth clenching, breath holding, and sudden falling. These symptoms only last for a few seconds or minutes. However, when someone has a convulsion that lasts for an unusually longer time or in a different manner compared to an epileptic seizure, one may suspect a pseudoseizure. PNES is a common psychiatric disorder that may result from stress and lead to malingering.
People who are exhibiting pseudoseizures may convulse and appear to lose consciousness. They may also express feelings of intense fear ordéjà vu. Psychogenic pseudo seizures often last far longer than just a few minutes.
Watch the video below to see how a patient with pseudoseizures behaves:
What Are the Causes of Pseudoseizures?
While epileptic seizures are caused byelectrical misfiring in your brain, pseudoseizures do not originate from a physical dysfunction in your brain. Instead, a pseudoseizure may occur as a psychological reaction to severe trauma or stress, resulting in a factitious disorder for one to appear sick. It is common among people who are victims of child abuse. Some people, however, exhibit pseudo seizures as a form of malingering, which is intended to deceive others in order to excuse themselves from work, to obtain drugs, or receive financial compensation.
Pseudoseizures may affect people of different ages, but they are more commonly seen in teens and young adults, especially females.
How Are Pseudoseizures Diagnosed?
Pseudoseizures are often misdiagnosed as epileptic seizures. Some health care providers are hesitant to make a diagnosis of pseudo seizures because they do not want to appear like they are accusing the patient of deception or overreacting. To differentiate the two conditions, doctors may monitor your brain activity using an electroencephalogram (EEG) while using video to record your convulsions. This is the best way to measure your brain activity, because it is an objective test compared to video recording your seizure alone.
What Are the Treatments for Pseudoseizures?
A doctor must carefully advise a patient who is found to have a negative diagnosis for seizures caused by epilepsy because this can cause anxiety, which may lead a patient to reject treatment. A doctor must explain their diagnosis in an open and sensitive manner. Here are some ways to break the diagnosis to affected patients and caregivers:
- Explain the objective reason why epilepsy has been ruled out
- Describe the condition they have, which is caused by dissociation
- Emphasize that they are not doubted as having attacks
- Explain that they are not going "mad"
- Explain that triggering "stresses" are sometimes not immediately obvious
- Explore relevance etiological factors relevant to their case (such as childhood trauma)
- Explore factors that contribute to stress
- Reassure them that their symptoms may improve after the diagnosis
- If using anticonvulsant drugs, caution them that withdrawal should be done gradually
- Offer psychological treatment
Patients may respond to psychotherapy, which is the most frequent treatment used for this condition. It may include insight-orientated therapy, cognitive behavioral therapy, and group work. Some evidence suggests the use of selective serotonin reuptake inhibitor (SSRI)antidepressants for patients with this disorder.
What Is the Prognosis of Pseudoseizures?
Studies show that patients with a diagnosis of PNES have relatively poor outcome. It has been found that about two-thirds of patients with pseudoseizure continue to have episodic attacks, with more than half of these being dependent on medical financial assistance for years. Data from referral-based epilepsy centers also show that a number of patients are lost to follow-up. However, studies show that outcomes are better in patients who have higher IQ, greater educational attainment, higher social status, younger age, and in those whose attacks are less dramatic or are accompanied by fewer physical complaints.