Non-epileptic seizure

Non-epileptic seizures (NES), also known as non-epileptic events, are paroxysmal events that appear similar to an epileptic seizure but do not involve abnormal, rhythmic discharges of neurons in the brain. Symptoms include shaking, loss of consciousness, and loss of bladder control. Some people have symptoms like those epileptic seizures. But non-epileptic seizures do not involve any unusual electrical activity in the brain. They usually relate to psychological, neurological, or physical trauma. It may take time to diagnose. NES are real, and people who are suffering do not have conscious and voluntary control over them. Non-epileptic seizures are similar to epileptic seizures external, even though their cause is very dissimilar. Non-epileptic seizures may look like generalized convulsions similar to grand mal epileptic seizures. People with NES sometimes need to make some life adjustments. Seizures may affect a person’s daily activities like the ability to work and drive vehicles. Some people are confused about their condition.

They may or may not be caused by either physiological or psychological conditions. Physiological causes include fainting, sleep disorders, and heart arrhythmias. Psychological causes are known as psychogenic non-epileptic seizures. Diagnosis may be based on the history of the event and physical examination with support from heart testing and an EEG.

Terminology

The International League Against Epilepsy (ILAE) define an epileptic seizure as "a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain." Convulsive or non-convulsive seizures can occur in someone who does not have epilepsy – as a consequence of head injury, drug overdose, toxins, eclampsia or febrile convulsions. A provoked (or an un-provoked, or an idiopathic) seizure must generally occur twice before a person is diagnosed with epilepsy.

When used on its own, the term seizure usually refers to an epileptic seizure. The lay use of this word can also include sudden attacks of illness, loss of control, spasm or stroke. Where the physician is uncertain as to the diagnosis, the medical term paroxysmal event and the lay terms spells, funny turns or attacks may be used.

Signs and symptoms

NES symptoms are similar to those of generalized epileptic seizures. This may include:

• Convulsions
• Crying out or making a noise
• Stiffening
• Jerky, rhythmic or twitching motions
• Falling down
• Loss of consciousness
• Confusion after returning to consciousness
• Loss of bladder control
• Biting the tongue

NES have some additional symptoms similar to partial seizures. These symptoms may include:

• Jerky or rhythmic movements
• Sensations such as tingling, dizziness, and feeling full in the stomach
• Repetitive motions
• Staring
• Confusion
• Changes in emotions
• Altered senses

Causes

Possible causes include:

• Syncope (fainting)
  • Reflex anoxic seizures
• Breath-holding spells of childhood
• Cataplexy
• Hyperekplexia, also called startle syndrome
• Migraine
• Narcolepsy
• Non-epileptic myoclonus
• Opsoclonus
• Parasomnias, including night terrors
• Paroxysmal kinesigenic dyskinesia
• Repetitive or ritualistic behaviours
• Tics
• Hypoglycemia

Type

Depending upon the source of seizures, NES can be categorized into three types.

*Epileptic Seizures- Though NES and epileptic seizures share common symptoms, they are not the same. The cause behind Epileptic seizures is an electrical interruption in the brain, when it occurs it distorted the transmission between brain cells. People may acquire epilepsy due to brain damage, head trauma, and some infectious diseases. Whereas NES do not include electrical interruptions in the brain. NES usually occurs due to psychological, neurological, or physical problems.

*Psychogenic Nonepileptic Seizures (PNES)-Psychogenic nonepileptic seizure (PNES) involves incidents that seem like epileptic seizures. But it does not cause by abnormal electrical activity in your brain. Instead, the seizures are a physical reaction to underlying psychological distress. The differential diagnosis for PNES is conversion disorder. Conversion disorder is also known as functional neurological symptom disorder. People with PNES have no conscious or voluntary control over them. PNES has been referred to as pseudo seizures in the past. The term “pseudo” had been used to define that the person is pretending to have a seizure but has not actually had a seizure, but this is not the scenario. This is the reason the preferred term is psychogenic nonepileptic seizures (PNES). It has been referred to as conversion disorder because the person is unaware of what is happening and is not consciously pretending to have a seizure.

Though there is a difference between PNES and epileptic seizure, their symptoms can be comparable. Symptoms may include:

• Sudden non-responsive
• Shaking movements
• Pelvic thrusting
• Shaking movements
• Shaking the head from side to side
• Clenching the mouth and closing the eyes
• physiologic nonepileptic events
• Staring spells
• Thrashing wildly
• Stuttering
• Shouting Phrases
• Being startled by loud noise or other stimuli
• Lack of drowsiness after an episode

*Physiologic Nonepileptic Events- There are various conditions that can cause Physiologic nonepileptic seizures. The conditions may include, sudden changes in the blood supply to the brain or in the sugar or oxygen levels in the brain. These include changes in heart rhythm, syncopal episodes, or hypoglycemia. Other physical conditions, such as sleep disorders and movement disorders, may have symptoms or episodes associated with them that can look like seizures.

Diagnosis

A wide array of phenomena may or may not resemble epileptic seizures, which may lead to people who do not have epilepsy being misdiagnosed. Indeed, a significant percentage of people initially diagnosed with epilepsy will later heal. In one study, the majority of children referred to a secondary clinic with "fits, faints and funny turns" did not have epilepsy, with syncope (fainting) as the most common alternative. In another study, 39% of children referred to a tertiary epilepsy centre did not have epilepsy, with staring episodes in mentally challenged children as the most common alternative. In adults, the figures are similar, with one study reporting a 26% rate of misdiagnosis.

Differentiation of a non-epileptic attack from an epileptic seizure includes the patient keeping their eyes closed and rarely causing themselves harm (both more common in non-epileptic attacks)

The most useful test in confirming epilepsy is an electroencephalogram (EEG). Different types of epilepsy can be identified with these patterns. A patient with NES will not show unusual electrical activity in the brain on the EEG. If the doctor suspects NES the patient will be referred to a psychologist for further diagnosis and treatment.

If any person presents with symptoms that seem to be a seizure, may be experiencing in fact an epileptic seizure. The accuracy of diagnosis is critical to a person receiving the correct treatment.

• A complete medical, neurologic, and psychiatric history
• A description from any family members who may have witnessed an event
• Results of prior diagnostic testing (brain imaging, bloodwork, EEG, cardiac testing)
• Response to prior treatment with antileisure medications
• A complete medical and neurologic examination

The standard test to help tell an epileptic seizure from a PNES is video-electroencephalography (vEEG). This test records both the outward appearance of the event on video and the electrical activity of the brain that occurs before, during and after the event.

Prognosis

After diagnosis 20 and 50% of people stop having PNES even without any specific treatment. Research showed that half of the people noticed an improvement after 3 months of psychological therapy. People with severe psychiatric symptoms face greater challenges. A person only has a brief history of PNES will stop after diagnosis.

Treatment

Psychotherapy is the most common treatment for NES. NES does not respond to anti-seizure medications. However, medications for depression or anxiety may be used as part of the treatment plan. cognitive behavioral therapy is the most useful treatment in NES. It examines the connection between a person's thoughts and feelings and behaviors. CBT and other psychotherapies take several months to work. It is important that the patient continue their treatment plan during this time.

Below describes some tactics that many people find helpful. It may well take time to learn some of the techniques and to feel the benefits from them.

1. Sensory Grounding: There are a number of ways of doing 'sensory grounding' but the one described below has been found to be helpful by many people. It is helpful to practice this when you are feeling OK just to remember it better way when needed. Explain it to the people close to you to get help when needed. Many people find it helpful to carrying something rough or textured around with them helpful.

• Feel something rough or textured, with your fingers and thumbs. Really focus on what this feels like as you rub it harder, or softer, or in different directions.
• Look around you and really focus on the things you can see.
• Listen and see what sounds you can hear
• Remind yourself that you are safe

2. Relaxation: Many people find that their non-epileptic seizures are more likely to happen when they are tense. If you are tense you may find yourself squeezing your hands together. You may tap your hands or feet. In this case, some kind of regular relaxation may be helpful.

• Many relaxation CDs are available, which describe how to tense and relax your different muscle groups.
• Choose whatever works for you, or maybe just stop everything, and give yourself time to unwind.

3. Abdominal breathing: Many people with non-epileptic seizures experience hyperventilation. It can make you feel strange, light-headed, and more likely to have a seizure. Abdominal breathing controls your breathing. It can help you to fight off a seizure and feel calmer.

• Sit comfortably with one hand on your abdomen below the navel.
• Slowly breathe in through your nose, and as you breathe in feel your stomach expand beneath your hand.
• Pause for a count of 3.
• Slowly breathe out through your nose and as you do so think "Relax".
• Rest for a moment.

Time out on the spot:- This technique can be use when you feel stressed or anxious. You can use it anywhere or anytime, without letting anyone know. Just take a few minutes out of the stressful situation to go to the relaxing place in your mind.

• Think about a place you have been where you felt happy and relaxed.
• Imagine yourself in that place.
• Get the image fixed in your mind so that you can call it up whenever you like.
• when you are feeling stressed, imagine yourself opening a door which takes you to this place.

Understand your triggers :- If you can start to understand what causes the seizure. way to do this is to keep a seizure diary. Write down each time you have a seizure, particularly make note of things that might have caused the seizure. For some people the seizure comes straight after the trigger, for others it could even be the following day.

External links

• What are Non-Epileptic Seizures? from Cleveland Clinic