Psychogenic Non-Epileptic Seizures

Psychogenic non-epileptic seizures (PNES) are behavioral events that resemble epileptic seizures, but are not caused by electrical disruptions in the brain. EEG testing shows no electrical disturbance associated with typical spells. They are caused by stressful psychological experiences or emotional trauma.

Non-epileptic seizures can be thought of as a type of coping mechanism in people with overwhelming stress. Psychological conflicts are translated into a physical symptom -- the seizure. They are not intentional, but rather are created as a psychological defense mechanism to keep internal stress out of conscious awareness. In many patients, the seizures are part of post-traumatic stress disorder (PTSD).

PNES or epilepsy?

Psychogenic non-epileptic seizures (PNES) are commonly misdiagnosed as epilepsy. In comprehensive epilepsy programs they represent 20-80% of referrals. Non-epileptic seizures occur more frequently in women (70%) than in men. Approximately 15% of patients who have non-epileptic seizures have both epileptic and non-epileptic seizures. If you have both types, it is important that you and your family attempt to distinguish between the two. This can be determined while you are being monitored in the Epilepsy Monitoring Unit (EMU).

Psychogenic non-epileptic seizures are sometimes referred to as "pseudoseizures." This term has a derogatory connotation and we try to avoid using that term for this reason. The preferred term is non-epileptic seizures.

Many patients with non-epileptic seizures are relieved to learn that they do not have epilepsy, and may only need short-term treatment, to learn how to control their spells. The treatment may not even involve use of medications. This is much different than adults with epilepsy who generally need lifelong medication treatment for epilepsy. Other patients with non-epileptic seizures may react with disbelief and have a more difficult time accepting the diagnosis because of the stigma attached to having a psychological condition.

Are people who have non-epileptic seizures "faking it"?

It is important to recognize that non-epileptic seizures are "real seizures," despite being different from epileptic seizures. In the past, patients experiencing non-epileptic seizures were thought to be seeking attention or faking them. We now understand that there is nothing false or insincere about most non-epileptic seizures.

It is quite rare to find someone who is deliberately faking a seizure just as it is rare to find people who fake having other medical conditions. Usually, the circumstances for faking seizures are as obvious as when a child pretends to be ill to avoid going to school when he or she did not finish a homework assignment or is unprepared for a test. Whatever the cause, it is extremely important to make an accurate diagnosis so that appropriate treatment can be offered. Adjustments in lifestyle are likely to be different for a person with non-epileptic seizures than for a person with epilepsy.