Seizures are temporary attacks or events involving abnormal movements, unconsciousness, other experiences or a combination of these. Epileptic seizures result from sudden abnormal electrical discharges in the brain. Non-epileptic seizures (NES) look like epileptic seizures but they are not caused by abnormal electrical discharges. Other names for NES include pseudoseizures , psychogenic seizures, non-epileptic attacks, non -epileptic events. We prefer the term “non-epileptic seizures” (NES) and we refer to each episode of a NES as an “event”.
NES are the most common condition mistaken as epilepsy. Their frequency is comparable to multiple sclerosis. One in five patients sent to epilepsy centers for difficult-to-treat seizures are determined to have NES instead of epilepsy.
Yes. Some patients can have a combination of both epileptic seizures and other events that show no epileptic or electrical activity in tests that determine seizures' origins.
The diagnosis of NES is based on a combination of clinical characteristics of the seizures or events (type of movements, spells or combination of symptoms, duration, frequency) and findings from video-electroencephalogram (v-EEG) monitoring. During v-EEG monitoring the patient is monitored for hours to days with a video camera and an EEG until a seizure or event occurs. Unfortunately, this procedure can only be done if the episodes occur frequently enough. There are other tests that can be used based on the episodes characteristics, but v-EEG is considered the most accurate way to diagnose NES.
It is very important that past records are reviewed by your epileptologist . A past ‘abnormal' EEG can mean different things (from showing epileptic discharges to showing abnormalities not diagnostic of epilepsy) and that is why it is important that your epileptologist takes a look at those past studies when available. Some patients might have been misdiagnosed as having epilepsy for years and, as explained above, others might have a combination of epileptic seizures and non-epileptic events. Sorting out these things is part of our evaluation and the evaluation done by your epileptologist .
The origin of NES, once other potential physiological causes have been ruled out, is not well-understood. The most accepted hypothesis is that NES are a manifestation of stress. Some patients are well-aware that they have been struggling with emotional difficulties and have seen mental health professionals for years; other patients have never seen a mental health professional and they cannot identify any specific source of stress in their lives. Many people with NES also suffer from other psychiatric problems such as depression, anxiety, problems with relationships, history of childhood abuse, etc.
What is important for patients and family members to understand is that the fact that the events are non-epileptic in origin does not mean that they are voluntarily or purposefully fabricated.
When you contact the clinic, trained clinical staff will ask you questions to ensure you could benefit from our comprehensive evaluation. If so, we will schedule an initial appointment for a detailed clinical evaluation and discussion of treatment options. Treatment duration and success will depend on a number of factors. There is no quick-fix here, but some studies are showing promising results when patients are committed to the offered psychological treatment.
This is a very important point. This will depend on each case and needs to be carefully discussed with your epileptologist or neurologist. In the case it is clear that you do not need to take anti-epileptic medications, you should follow the instructions of your epileptologist or neurologist and should never stop these medications without their supervision and guidance.
Yes. A diagnosis of non-epileptic seizures requires a video EEG showing no epileptic activity during a typical event when possible. Usually, the doctor ordering or performing this test will refer you to our clinic. If this test has not been done, your evaluation will include a referral for this test. We will need a copy of the report.
If your seizures are non-epileptic in origin and you do not have epilepsy, whether you can drive or not will be determined by your psychiatrist and your neurologist.
For more information or to set up an appointment, please contact Angela Roiko, LCSW at 312.355.6347 or nesic@psych.uic.edu