Pseudoseizure Signs and Symptoms with Examples: Understanding Psychogenic Non-Epileptic Seizures (PNES)

Pseudoseizures, also known as psychogenic non-epileptic seizures (PNES), are episodes that resemble epileptic seizures but do not result from abnormal electrical activity in the brain. Instead, pseudoseizures are considered a form of psychological expression, often associated with underlying emotional or psychological issues.

1. Physical Movements and Convulsions:

• Symptom: Repetitive and jerky movements resembling epileptic seizures.
• Example: Namita experiences episodes where her limbs twitch and jerk, similar to the convulsions seen in epileptic seizures. However, these movements lack the rhythmic pattern associated with true seizures.

2. Altered Consciousness:

• Symptom: Lack of responsiveness or altered awareness during the episode.
• Example: During a pseudoseizure, Anuj may appear unresponsive, but he can recall details of the event afterward. This contrasts with epileptic seizures, where consciousness may be lost.

3. Emotional Triggers:

• Symptom: Pseudoseizures often have emotional triggers such as stress, anxiety, or trauma.
• Example: Drishti consistently experiences pseudoseizures before public speaking engagements due to her fear and anxiety about public performance.

4. Inconsistent Duration:

• Symptom: Episodes may vary in duration, often lasting longer than typical epileptic seizures.
• Example: David’s pseudoseizures can last for extended periods, sometimes lasting several minutes, unlike the shorter duration common in certain types of epileptic seizures.

5. Unusual Vocalizations:

• Symptom: Vocalizations or sounds that do not align with typical seizure characteristics.
• Example: Jessica’s pseudoseizures include unusual vocalizations, such as humming or speaking in a manner inconsistent with the features of epileptic seizures.

6. Abrupt Onset and Offset:

• Symptom: Episodes may start and stop abruptly without the gradual progression seen in some epileptic seizures.
• Example: Rajkumar experiences sudden and unexpected episodes of pseudoseizures that cease abruptly, without the postictal confusion often associated with epileptic seizures.

7. Response to External Stimuli:

• Symptom: Pseudoseizures may be influenced by external stimuli, such as attention or specific triggers.
• Example: Asma’s pseudoseizures tend to occur more frequently when she receives attention or is in situations that evoke emotional distress.

8. Memory of the Episode:

• Symptom: Individuals usually retain a clear memory of the events during pseudoseizures.
• Example: David can recall specific details of his surroundings and conversations during a pseudoseizure, a feature not commonly observed in epileptic seizures.

9. Observable Inconsistencies:

• Symptom: Pseudoseizures may exhibit inconsistencies in the pattern and nature of movements.
• Example: During a pseudoseizure, Lalita’s movements lack the stereotyped and rhythmic pattern seen in certain types of epileptic seizures.

10. Response to Medication:

• Symptom: Pseudoseizures do not respond to anti-seizure medications that are effective for epileptic seizures.
• Example: Despite being prescribed anti-seizure medication, Michael’s pseudoseizures persist, indicating their psychogenic origin.

Causes and Contributing Factors:

Psychological Trauma: Pseudoseizures are often linked to past psychological trauma or unresolved emotional conflicts.

Conversion Disorder: Pseudoseizures are considered a type of conversion disorder, where psychological distress is expressed through physical symptoms.

Mental Health Conditions: Underlying mental health conditions, such as anxiety, depression, or post-traumatic stress disorder (PTSD), may contribute to the development of pseudoseizures.

Somatic Symptom Disorder: Individuals with a heightened focus on physical symptoms may be more prone to experiencing pseudoseizures, particularly if they have somatic symptom disorder.

Diagnosis and Treatment:

Video EEG Monitoring:

Video EEG monitoring is a key diagnostic tool to distinguish between epileptic seizures and pseudoseizures. Observing the episodes alongside EEG data helps in accurate diagnosis.

Psychiatric Evaluation:

A comprehensive psychiatric evaluation is crucial to identify underlying mental health conditions and contributing psychological factors.

Therapy and Counseling:

Psychotherapy, especially cognitive-behavioral therapy (CBT), can be effective in addressing the emotional triggers and psychological factors contributing to pseudoseizures.

Medication Management:

While medications are not typically used to treat pseudoseizures directly, they may be prescribed to manage any underlying mental health conditions.

Patient Education:

Educating individuals about the psychogenic nature of pseudoseizures and helping them understand the mind-body connection is an essential aspect of treatment.

Conclusion:

Pseudoseizures pose a unique challenge in the medical field due to their overlap with epileptic seizures. A multidisciplinary approach involving neurology, psychiatry, and psychology is crucial for accurate diagnosis and effective treatment. Addressing the underlying emotional and psychological factors is key to helping individuals manage and overcome pseudoseizures, allowing for improved overall well-being. If you or someone you know is experiencing symptoms resembling seizures, seeking professional medical and psychological evaluation is essential for proper diagnosis and care.