PNES

PSYCHOGENIC NON—EPILEPTIC SEIZURES:

There are several different types of seizures, and they can happen for many different reasons. Seizures that are not due to epilepsy are sometimes called ‘non-epileptic seizures’. They can have a physical cause such as low blood sugar (hypoglycaemia) or something related to the way the heart is working.

Or non-epileptic seizures may have a psychological cause. Other names for non-epileptic seizures with a psychological cause include ‘non-epileptic attack disorder’, ‘psychogenic seizures’ and ‘dissociative seizures’. The term ‘non-epileptic seizure’ is the most widely used term.

Epileptic seizures are caused by a disturbance in the electrical activity of the brain (and so they always start in the brain). Our brain controls the way we think, move and feel, by passing electrical messages from one brain cell to another. If these messages are disrupted, or too many messages are sent at once, this causes an epileptic seizures.

What happens to the person during the seizure depends on where in the brain the seizure activity happens. Non-epileptic seizures (NES) are not caused by disrupted electrical activity in the brain and so are different from epilepsy.

Non-epileptic seizures (NES) can be divided into two types: organic non-epileptic seizures and psychogenic seizures.

Organic non-epileptic seizures have a physical cause (relating to the body). They include fainting (syncope) and metabolic (biochemical processes in the body) causes such as diabetes. Because organic NES have a physical cause, they may be relatively easy to diagnose and the underlying cause can be found. For example, a faint may be diagnosed as being caused by a physical problem in the heart. In these cases, if the underlying cause can be treated the seizures will stop.

Some NES are called ‘psychogenic seizures’. ‘Psychogenic’ means they are caused by mental or emotional processes, rather than by how the brain and nervous system functions (a neurological cause). Psychogenic seizures may happen when someone’s reaction to painful or difficult thoughts and feelings affects them physically.

Psychogenic seizures include different types:

  • Dissociative seizureshappen unconsciously, which means that the person has no control over them and they are not ‘put on’. This is the most common type of NES.
  • Panic attackscan happen in frightening situations, when remembering previous frightening experiences or in a situation that the person expects to be frightening. Panic attacks can cause sweating, palpitations (being able to feel your heart beat), trembling and difficulty breathing. The person may also lose consciousness and may shake (convulse).
  • Factitious seizuresmeans that the person has some level of conscious control over them. An example of this is when seizures form part of Münchausen’s Syndrome, a rare psychiatric condition where a person is driven by a need to have medical investigations and treatments.

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Psychogenic nonepileptic seizures (PNES) are an uncomfortable topic, one which is difficult for both patients and healthcare professionals to discuss as well as treat, and yet it is estimated that PNES are diagnosed in 20 to 30% of patients seen at epilepsy centers for intractable seizures.

What I had were dissociative Psychogenic Non-Epileptic Seizures. These seizures are an unconscious reaction so they are not deliberate and I had no control over them. The cause was unknown in my case.  For some, they start shortly after a specific event. For others, they may not start until years later or they may start suddenly for no apparent reason.  However, I believe it was a combination of the medication I was on, the experience I had with smoking some marijuana that was laced with something, as well as the emotional stress experienced during that year.

Although DS start as an emotional reaction they cause a physical effect. Features of the seizures can include palpitations (being able to feel your heart beat), sweating, a dry mouth and hyperventilation (over-breathing). Some features of DS are very similar to epileptic seizures. These physical features include loss of awareness, loss of sensation, and loss of control over bodily movement (which may include having convulsions).

In my case, I did not have a single seizure that mimicked an actual epileptic seizure. There was no convulsions or loss of control over my body. Instead, I felt “out of touch” with reality, or depersonalized. I had a difficult time concentrating on anything which included hearing what people said or reading things because I seemed to be so far off in my own world. (Although, I do not recall being able to have a thought of my own, either.) So, if someone were to say something to me, my mind didn’t quite comprehend what was said, and therefore it was repeated over and over again in my mind. I called my episodes or seizures “repeating” because of this. My eyes would also blink and flutter rapidly, so closing them was very difficult. Unfortunately, the only way for my seizures to stop was to go to sleep and sleep it off. This was difficult to achieve because of the fluttering eyelids. Eventually I was able to discover that a dose of the anti-anxiety medication clonazepam (klonopin) would stop the seizures shortly after they began.

Patients with dissociative attacks often find it even harder to describe their attacks than patients with epilepsy. This was the case for me. I could not describe my seizures accurately to my psychiatrist or my neurologist. The above description honestly even the most accurate one I could come up with. But, because of the length of the seizures, and because my EEG came back negative for epileptic activity, I was diagnosed with non-epileptic seizures. These seizures ended in late 2014 after coming off the psychiatric medication I was started on in 2011. I’ve only had one since, and that was in June 2015 after a Lumbar Puncture that I fainted during. When I woke up, I had one of these attacks.