Pseudoseizure disorder

Written by michelle kerns
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Pseudoseizure disorder
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Pseudoseizure disorder--also known as psychogenic nonepileptic seizures, or PNES--is a neurological disorder in which an individual experiences epileptic-type seizures known as pseudoseizures. Pseudoseizures differ from typical seizures in a number of ways, though differentiating between the two can be difficult, and often, individuals with epilepsy can suffer from a combination of both.

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Definition

Pseudoseizure disorder is a type of conversion disorder, which is a condition in which a person displays neurological symptoms while at the same time exhibiting signs of stress and hysteria. This particular disorder is characterised by periods of seizure-like activity during which the person experiencing the seizure is still cognitively aware of his surroundings. Pseudoseizure disorder is also strongly linked in individuals with psychiatric problems such as multiple personality disorder and dissociative amnesia. Pseudoseizure activity is not typically diminished with the administration of antiepileptic drugs.

Differences

There are a number of characteristic differences between a pseudoseizure and an epileptic seizure. Individuals experiencing pseudoseizures usually close their eyes and resist attempts to open them. The intensity of a pseudoseizure usually remains constant from the beginning to the end of the episode, with each episode lasting, on average, about two minutes. Pseudoseizure disorder is much more common in women, particularly young women, with a history of mental problems. By contrast, individuals experiencing epileptic seizures generally keep their eyes open and experience a sharp spike, then decrease, in the intensity of the episode, which rarely lasts as long as pseudoseizures. A person suffering from an epileptic seizure will have elevated blood prolactin levels after the seizure. A person suffering from a pseudoseizure will not.

Cause

Pseudoseizure disorder is thought to be an unconscious, involuntary physical reaction to extreme psychological stress. This is supported by research that indicates pseudoseizure disorder is more likely in individuals suffering from dissociative disorders and other disruptive mental problems, particularly young women, who suffered from childhood abuse or trauma.

Diagnosis

The best way to diagnose pseudoseizure disorder is with the use of video-EEG monitoring during an actual seizure episode. In this method, both videotape of the episode and an EEG (electroencephalogram), which monitors and records electrical activity in the brain, are recorded simultaneously. The EEG is particularly useful: since pseudoseizures are psychological in origin and are not a result of electrical "storms" in the brain, the EEG of a person experiencing a pseudoseizure will look very different from that of an EEG of a person experiencing an epileptic seizure.

Treatment

The incidence and frequency of pseudoseizures does not decrease with the use of antiepiletic drugs. However, because many individuals with epilepsy experience both real seizures and pseudoseizures, the condition, by itself, can be difficult to isolate and treat. When pseudoseizure disorder has been positively diagnosed, psychotherapy, often in conjunction with medication, such as antidepressants, is the most common treatment.

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