Fits Specialist Doctor in Hyderabad

Pseudo seizures or Psychogenic Non-epileptic seizures (PNES) look similar to epileptic seizures. They are not epileptic and may be due to psychological causes. Seizures of this type are also known as nonepileptic seizures (NES). PNES look like partial complex seizures (focal impaired awareness) or absence seizures.

NES is also known as non-epileptic attack (NEA) or non-epileptic attack disorder (NEAD) or dissociative seizures.

What are pseudoseizures?

PNES are not caused by impaired brain electrical discharges. They are sign and symptoms of psychological distress. People having this condition seem to have been experiencing seizures (generalized convulsions) with typical symptoms like repetitive shaking and falling. PNES, in other words, is the condition wherein a group of psychiatric conditions manifest as physical symptoms (somatoform disorders) or somatic symptoms disorders or dissociative disorders.

Approximately 20 to 30% of people seen at epilepsy centres are estimated to have NES.

Types of NES?

NES are broadly classified into two types: organic non-epileptic seizures and psychogenic seizures.

Organic NES

This type of seizures has a physical cause: syncope (fainting) related to the body and metabolic (diabetes) due to biochemical processes in the body. NES can be easily diagnosed if the underlying cause is found. For instance, fainting (syncope) can be due to a problem in the heart. If the problem is treated, seizures will stop.

Psychogenic NES

It can be due to psychological cause (emotional or mental processes). Therefore, they are known as Psychogenic Non-epileptic seizures (PNES).

They include dissociative seizures, factitious seizures and panic attacks (frightening experiences or situations).

The symptoms of panic attacks include palpitations (fast heartbeats), trembling, sweating and breathing difficulty. In severe attacks, the person may lose consciousness and shakes (convulse).

Why NES are difficult to diagnose?

NES do not have any specific and distinct symptoms, which will help clearly identify them from epileptic seizures. Therefore, they appear similar to epileptic seizures and are difficult to diagnose.

PNES Misdiagnosis

Misdiagnosis of Individuals with PNES is common. It is estimated that approximately 25% of people diagnosed to have epilepsy do not respond to treatment by drug therapy. They are found to have been misdiagnosed as epileptic. Owing to this reason, there is often a diagnostic delay. For timely diagnosis, it is better to approach fits specialist doctor in Hyderabad.

Causes

Specific traumatic events and other psychological causes – emotional disturbances, severe mental stress, anxiety or generalized anxiety disorder (GAD), panic attacks, attention deficit hyperactivity disorder (ADHD), traumatic injuries, obsessive-compulsive disorder (OCD) and depression can cause NES.

NES are a manifestation of trauma, which is also known as post-traumatic stress disorder (PTSD). If a child experiences trauma (sexually abused, physically abused or witness violence), his or her body absorbs that trauma.

PNES Signs and Symptoms

Symptoms of Pseudo seizures are similar to epileptic seizures and include:

  • Confusion
  • Lack of awareness of surroundings
  • Loss of attention
  • Staring blankly
  • Rigidity
  • Loss of consciousness
  • Falling down
  • Involuntary muscle stiffening, convulsing and jerking

Diagnosis

Non-epileptic seizures in children are diagnosed by a paediatric neurologist who specializes in the diagnosis and treatment of seizures. The doctor tries to know the psychiatric or psychological cause. During the diagnosis, the neurologist tries to rule out epilepsy first. The doctor may ask a few questions about the child’s personal history of seizures and neurological disorders; mental health issues (depression & anxiety); family history of seizures; previous use of anti-epileptic drugs.

The pediatric neurologist will also ask about the seizures: duration, frequency, number of episodes, warning signs; how did the child felt during and after the seizure; how long did it take for the child to recover and also any activity that the child did and remember during the seizure.

The tests to rule out epilepsy include blood tests, brain scans (CT or MRI to know the physical cause of epilepsy); and an EEG (electroencephalogram). NES are not caused by changes in brain activity.

Video EEG Monitoring

Video EEG monitoring helps in positively making the diagnosis. In this test, EEG is done and filmed at the same time. This helps to know the brain activity and the action the child is doing during the seizure. Thus, video EEG helps in making out the difference between non-epileptic and epileptic seizures. If the brain activity changes during a seizure, it will help in diagnosing epilepsy. If the brain activity does not change during a seizure, it will be helpful in diagnosing NES.

In the absence of neurological or physical cause, the seizure may be considered as NES and the patient will be referred to a psychiatrist or psychologist for diagnosis. They help in identifying any underlying psychological cause or conditions, which could be behind pseudoseizures.

For the effective treatment of Pseudo seizures, a team comprising pediatric neurologist, psychiatrist and psychologist work together.

Treatment

Treatment with psychotherapies and medications for underlying psychological and psychiatric issues have been shown to be effective.

Psychotherapies include Cognitive Behavioural Therapy (CBT), Mindfulness-Based Psychotherapy, Interpersonal and Psychodynamic Psychotherapy, Prolonged Exposure Psychotherapy, body-centred therapies and Family Therapy.

Working with a psychologist, psychiatrist, or pediatric neurologist (fits specialist doctor in Hyderabad) is a vital part of the treatment.

Bottom Line

Any parent worried about their child’s seizures not responding to epileptic medicines, should talk to their pediatric neurologist. The seizures and the symptoms could be due to pseudo-seizures – which may require a completely different treatment approach. The treatment aims at treating the underlying psychological cause to help manage the symptoms.

Dr. Habib Pathan

Fits Specialist Doctor in Hyderabad