Dissociative seizures: causes, symptoms and treatment

Dissociative seizures are similar to epileptic seizures in that they cause episodes of involuntary movement and behavior. However, while epileptic seizures result from abnormal electrical signals in the brain, dissociative seizures occur for psychological reasons.

Dissociative seizures can look like epileptic seizures, which means that many people are initially misdiagnosed. This can be harmful because epilepsy treatments and medications will not work for a person who has dissociative seizures.

However, once doctors make the correct diagnosis, people can start psychotherapy to treat the underlying cause of the seizures. With treatment, dissociative seizures can improve considerably or disappear completely.

This article discusses the symptoms, causes, diagnosis, and treatment of dissociative seizures. It also offers tips for dealing with the condition.

Dissociative seizures are a type of non-epileptic seizure resulting from psychological distress. They cause episodes of involuntary movement or behavior. In the United States, doctors call these seizures non-epileptic psychogenic seizures (PNES).

During PNES, a person has dissociated, which means that they are not fully aware or in control of themselves. They may fall in and out of consciousness or become numb for brief periods.

PNES can be very similar to epileptic seizures. However, PNES does not cause misfire in the brain. This difference is one of the main ways that doctors distinguish the two types.

For the same reason, these seizures cannot damage the brain. A person only needs emergency treatment for a dissociative seizure if they injure themselves.

It is not known how common PNES is, but among people who require monitoring in a hospital for unusual seizures, 20-40% receive this diagnosis.

Other names for PNES include non-epileptic psychogenic episodes or pseudo-epilepsies. However, many people think that the older term “pseudo-sequence” is unacceptable because it implies that the symptoms are not real, which creates stigma.

Symptoms of PNES can vary, but they often include:

  • change levels of consciousness
  • shaking or jerking movements
  • pelvic thrust
  • shake your head from side to side
  • brief episodes of non-responsiveness
  • screaming, crying or other vocalizations
  • eyes or mouth closed

Yes, it is possible that the two types of seizures coexist. An older review from 2013 indicates that approximately ten% of people with PNES also have epilepsy. This co-occurrence can make the diagnosis of PNES more difficult.

However, there are some key differences between seizures and non-epilepsy. For example, the eyes are closed for about 95% dissociative seizures, which are open during most epileptic seizures.

Likewise, being able to speak or scream during a seizure can be a sign of PNES, as can jumping at the sound of a loud noise, which is not common during a seizure.

PNES appears to be an involuntary response to severe emotional distress. The symptom is strongly associated with mental health issues, such as anxiety and depression, as well as past trauma.

Psychological trauma refers to the effects that extremely stressful events have on the mind. These events can include a one-time incident, such as a car accident, or multiple events that take place over an extended period of time.

A history of physical or sexual abuse is one of the risk factors for PNES, which may partly explain why Most people who live them are women. Women are more likely than men to experience these types of abuse, especially in childhood and in intimate relationships.

Some of the conditions that have an association with PNES include:

Mental health is complex and not everyone can identify a specific cause of their PNS. Even if it is, the episodes are real.

Doctors can sometimes diagnose PNES based on the difference between symptoms and those of epileptic seizures. They may be able to do this by observing or talking with the person or family members or friends who witnessed the seizures.

The next step is to rule out epileptic seizures by measuring electrical activity in the brain. Doctors can do this through electroencephalographic (EEG) video monitoring. During this test, an EEG monitor tests the electrical signals in the brain, while a camera records a seizure. The results allow a neurologist to make a diagnosis.

To perform a video EEG test, a person may need to stay in a monitoring unit or other healthcare facility.

The main treatment for PNES is psychotherapy. By speaking with a psychologist or therapist, people can begin to understand the underlying cause of seizures.

There are many types of therapy. The most studied type in the treatment of PNES is cognitive behavioral therapy (CBT). CBT works by examining the relationships between beliefs and thoughts, emotions and behaviors.

People with a history of traumatic experiences may benefit from traumatic therapies, which include a range of techniques that encourage the brain to process distressing memories, thereby reducing their impact.

Medication can help reduce symptoms of any coexisting mental health problem and improve quality of life. However, they will not reduce seizures.

PNES can be disruptive, frightening, or disorienting. While a person is on treatment, there are ways to minimize these effects. The UK’s National Health Service (NHS) recommends the following coping strategies:

Sensory grounding

If a person shows warning signs before a seizure, they may engage in sensory grounding. This involves the steps below:

  1. Find a rough or textured object to carry. When a seizure occurs, rub the object between your fingers, focusing on how you are feeling.
  2. Place your feet firmly on the floor and notice how sturdy it is.
  3. Find something nearby to look at and describe what it looks like, out loud or silently.
  4. Listen to sounds from the surroundings, such as birdsong or people talking.

This strategy can prevent seizures or delay them long enough for a person to get to a private and safe place.

Abdominal breathing

Abdominal breathing can promote calm and prevent a seizure. A person can follow these steps:

  1. Sit with one hand on your stomach, below the navel.
  2. Slowly breathe in through your nose and feel the stomach expand.
  3. Pause for 3 seconds, then breathe out slowly through your nose.
  4. Repeat for 20 breaths or until the warning signs of the attack have passed.

First aid in case of seizure

Although psychogenic seizures are not in themselves harmful, people can accidentally injure themselves during one. First aid for a seizure includes practices that prevent this from happening.

It is useful to inform friends, family or colleagues of what to do in the event of a crisis. They can help you by:

  • remove all potentially dangerous objects from the area
  • guide the person having the seizure to a safe place
  • put something soft under your head
  • talk to them calmly and reassuringly
  • not trying to restrict their movements or the noise they make, as this can be frightening and potentially lead to injury

If someone doesn’t feel any warning signs before a seizure, they may not be able to drive.

Non-epileptic seizures rarely require medical treatment or a call to emergency services. If someone is injured, it is important to call 911 and say that the seizure was not epileptic.

Identify the triggers

Certain emotional events or states can trigger PNES. Identifying what it is can help someone figure out how to reduce their seizures. It can be helpful to keep a journal to note when they occur and any factors that may have contributed to them.

However, it is important not to try to avoid all triggers as this causes isolation or prevents someone from doing the things they love. In the short term, it can reduce stress or embarrassment, but in the long term, it can make someone feel less capable or more overwhelmed by their condition.

A person should try to maintain a normal routine and independence as much as possible, but seek help if the symptoms of PNES are causing physical or emotional difficulties.

Dissociative seizures are a type of non-epileptic seizure that many refer to as PNES. They cause episodes of involuntary movements and behaviors that occur as a result of psychological distress. The similarity of dissociative seizures to epileptic seizures means that doctors misdiagnose some people with this condition.

Treatment for PNES can reduce the frequency of seizures and lessen the impact of any underlying mental health problem on a person’s life. If someone thinks they have PNES, they should have an evaluation by a neurologist to confirm the diagnosis.

About Michael Bill

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