Psychogenic Seizures: What You Need to Know?

Psychogenic seizures, previously referred to as pseudoseizures, are perplexing events that mimic epileptic seizures but are not caused by abnormal electrical brain activity. These episodes have long been linked to hysteria and psychiatric conditions, making them a fascinating subject of study.
These episodes can be challenging to understand, but delving into the complexities of psychogenic seizures is essential for anyone seeking a more profound comprehension of this enigmatic condition. In this comprehensive guide, we’ll explore the nature, symptoms, causes, and treatment options for psychogenic seizures, shedding light on a state that has long remained shrouded in mystery.
Whether you’re a patient, a caregiver, or simply curious about the intricacies of psychogenic seizures, this resource aims to provide clarity and offer valuable insights to help individuals journey to recovery and wellness.

Psychogenic Seizures

What are Psychogenic Seizures?

Seizures are sudden outbursts of electrical activity in the brain, which leads to vigorous body and extremity jerky movements. The eyes may turn to one side or roll upwards, frothing from the mouth, tongue biting, the passage of urine, or stools may happen, leaving the patient tired for the next few hours.
Psychogenic seizures, formerly known as pseudo seizures or non-epileptic seizures, mimic the physical characteristics of epileptic seizures but do not represent the manifestation of abnormal excessive synchronous cortical activity, which defines epileptic seizures. They are called psychogenic nonpileptic seizures (PNES) nowadays.
It is not always easy to differentiate between epileptic and non-epileptic seizures just by looking at them, and most of the time, the neurologists will have to rely on an electroencephalogram (EEG) to make the diagnosis. Due to the stigma associated with epilepsy and mental diseases, these often remain undiagnosed for years.

Why do psychogenic seizures occur?

The root lies somewhere in our emotions and thought processes. It has been seen that the patients may not be aware of their activity, and the pseudo seizures come involuntarily. Such a presentation is called conversion disorder. In some cases, there is history of physical or sexual abuse and mental trauma. A lot of patients tend to be associated with the healthcare industry. They may have an account of depression, anxiety and PTSD.
It’s essential to recognize the intricate connection between our minds and bodies to comprehend psychogenic seizures. Our emotions, thoughts, and experiences can profoundly impact our physical well-being. This mind-body connection is at the core of psychogenic seizures.
When someone experiences overwhelming emotions or psychological distress, their brain may respond by generating physical symptoms that resemble epileptic seizures. These symptoms can be very convincing and may include convulsions, loss of consciousness, and even foaming at the mouth.
In patients admitted to epilepsy monitoring units for unusual or intractable seizures, about 20% to 40% are diagnosed with PNES rather than epileptic seizures.

Diagnosing Psychogenic Seizures

Distinguishing psychogenic seizures from epileptic seizures can be challenging, even for experienced neurologists. Several factors help us diagnose psychogenic seizures. Movements such as pelvic thrusting, head nodding, waxing and waning consciousness, and shaking movements of the belly or chest are associated with pseudo seizures. In most of the seizure cases, the eye remains open. Tightly closed eyes or resisting eye opening during an event suggest pseudo seizures.
It is helpful if the events are recorded over a cell phone. These can be studied later to look for clues and make a diagnosis.
Electroencephalogram (EEG) and video EEG Monitoring: One of the most valuable tools in diagnosing psychogenic seizures is video electroencephalogram (EEG) monitoring. During this test, a patient is observed with continuous video recording while monitoring brain activity with an EEG. It allows us to correlate physical symptoms with brain activity, helping us identify whether the seizures are psychogenic or epileptic.
Psychological Assessment: A psychiatric evaluation can uncover underlying emotional and psychological factors contributing to the seizures. Identifying and addressing these factors are crucial steps in managing psychogenic seizures.

Differential Diagnosis

Certain diseases, although not psychogenic, can present, like pseudoseizures or seizures. These are vertigo, syncope, complex partial and absence seizures.

Treatment and Management

Once a diagnosis is confirmed, the focus shifts to treating and managing psychogenic seizures. It’s important to remember that psychogenic seizures are not a conscious choice by the individual but rather a manifestation of psychological distress. Therefore, a compassionate and holistic approach is essential.

Psychotherapy: Cognitive-behavioral therapy (CBT), dialectical-behavior therapy (DBT), and other forms of psychotherapy can be highly effective in helping individuals manage stress, anxiety, and emotional trauma that may trigger their psychogenic seizures.

Medication: While psychogenic seizures are not treated with antiepileptic drugs, medicines may be prescribed to manage coexisting psychological conditions like depression and anxiety.

Education: Education plays a significant role in the management of psychogenic seizures. Patients and their families should be informed about the condition to reduce the fear and stigma surrounding it.

Support: Encouraging a strong support system for the patient is crucial. Friends and family can provide emotional support and help individuals cope with their condition.

Mind-Body Techniques: Techniques such as relaxation exercises, yoga, and meditation can help individuals manage stress and reduce the frequency of psychogenic seizures.

The Importance of Compassion

It’s essential to approach individuals with psychogenic seizures with empathy and understanding. These individuals often struggle with complex emotional issues, and their seizures are their way of coping. Encouraging open communication and seeking professional help is the first step toward recovery.


Breaking the Stigma

Stigma can be a significant barrier for individuals with psychogenic seizures. Friends, family, and even healthcare providers may misunderstand the condition, leading to feelings of shame and isolation. Breaking this stigma is crucial for the well-being of those affected.

Conclusion

Psychogenic seizures are a part of a larger mind process and must be tackled delicately. A person suffering from such a disease is often ridiculed and stigmatized, leading to further isolation and worsening mental issues. The neurologist needs to discuss these issues with the patient, and then the family empathetically and formulate a plan. These can be easily managed if a conscientious and considerate approach is taken.

References:

1.Huff JS, Murr N. Psychogenic Nonepileptic Seizures.

[Updated 2022 May 8].

In: StatPearls [Internet].