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The Reality of Pseudoseizures


In the past, pseudoseizures–that is, seizures not the result of any clear physical ailment–were regarded as malingering, as fakery. That perception is changing, but the rest of the medical field hasn’t quite caught up.

This is a topic I am particularly close to since someone in my life has had a history of pseudoseizures. I saw firsthand how she was treated: doctors accused her of faking symptoms, of deliberately endangering her health in order to seek attention, of trying to get her hands on powerful narcotics to feed an addiction. But none of those were true. Instead, the seizures were a physical response to long-standing psychological trauma. While poorly understood compared to other conversion disorders, pseudoseizures operate similarly. They manifest psychological disorders via physical symptoms. They aren’t the result of runaway brain activity the way epileptic seizures are, but they are no less real.

Unfortunately, diagnosing them is difficult. They are usually mistaken for epileptic seizures and treated as such, but the medications designed to treat epilepsy have little or no effect on pseudoseizures. They may, as a side effect, suppress the psychological symptoms that lead to pseudoseizures, but they fail to address the underlying cause. Unlike epilepsy, pseudoseizures can be eliminated through psychological treatment–but only if they are identified properly and the patient receives adequate psychiatric care.

Clouding the issue even further is the coincidence of epilepsy and pseudosizures, also known as psychogenic non-epileptic seizures:

The first type of non-epileptic seizures, as defined by the Epilepsy Foundation, is psychogenic non-epileptic seizures. They’re seizures caused by psychological trauma or conflict that impacts the patient’s state of mind. **The Epilepsy Foundation states that sexual or physical abuse is the leading cause of psychogenic seizures,** where the abuse occurred during childhood or more recently: life changes, like death and divorce are another possible cause of a psychogenic seizures.  This form of seizure often resembles a complex partial or tonic-clonic (grand-mal) seizure, with generalized convulsions, stiffening, jerking, falling, shaking and crying. Less often, a psychogenic seizure resembles a complex partial seizure, with a temporary loss of attention. **Interestingly, about 1 in 6 of these patients either already has epileptic seizures or has had them.** So different treatment is needed for each disorder. Psychogenic non-epileptic seizures are most often seen in adolescents and young adults, but they also can occur in children and the elderly. **And they are three times more common in females!** Doctors have identified certain kinds of movements and patterns that seem to be more common in psychogenic seizures than in seizures caused by epilepsy. Some of these patterns do occur occasionally in epileptic seizures however, so having one of them does not necessarily mean that the seizure was non-epileptic. **Video-EEG monitoring is the most effective way of diagnosing non-epileptic seizures.** The doctor may take steps to provoke a seizure and then ask a family member or friend of the patient to confirm that the event was the same as the usual kind. Although there is trauma involved, psychogenic non-epileptic seizures do not necessarily indicate that the person has a serious psychiatric disorder. But the problem _does_ need to be addressed and many patients need treatment. Sometimes the episodes stop when the person learns that they are psychological. Some people have depression or anxiety disorders that can be helped by medication. Counseling for a limited time is often helpful.  And the prognosis is good, with 60 to 70 percent of patients alleviated of seizure symptoms.

I’ll note that video EEG monitoring was not undertaken in the case I’m most familiar with. It took years of seeking help through various channels before medical practitioners would even believe she had a real problem, rather than faking symptoms for attention. But, similar to what’s described above, once the seizures were properly identified as psychological in origin, and the underlying psychological issues were addressed, the incidence of such seizures declined dramatically and has, years later, virtually disappeared. This might lead one to believe that the doctors were right–that the seizures were false and were only present until the patient could talk herself out of having them. But having witnessed many of the episodes, there was no control here. What was required was real psychological treatment, and that was ultimately effective.

Pseudoseizures are very similar to other conversion disorders, so called because they convert psychological problems into physical symptoms. The medical field is improving in identifying and treating such seizures, rather than assuming patients presenting with symptoms are trying to waste their time, but there is still progress to be made. Better training would likely help alleviate this issue, especially in front-line medical staff such as emergency room doctors and nurses. At the very least, cases like the one I’ve described here should become less and less common–the cause of the seizures should be more quickly identified and addressed, rather than leaving patients to spend years facing accusations and mistreatment from healthcare providers, which only worsens the psychological factors involved.