Neurologic Diseases: Psychogenic Seizure

Psychogenic seizure, also called as pseudo seizure means a seizure like episode but not a true epileptic seizure. This seizure like episode may resemble a true epileptic seizure but in reality it is not at all epileptic in nature. It is a relatively common condition and managed frequently by a neurologist in conjunction with a psychiatrist and/or counselor (therapist).

This term is kind of discouraged now-a-days, however it is still widely used by both medical staff and patients. It is discouraged because this term may give a derogatory connotation that the patient is not real, mad, or faking the disease etc so the more preferred term for this condition are non epileptic seizure (NES), non epileptic attack, PNES (psychogenic non epileptic seizure) etc.

It is considered as a psychiatric disorder. It is generally included under somatoform disorder under the subheading of conversion disorder.

So this is not an epileptic attack. That means the characteristic neurochemcal changes that are associated with a true epileptic seizure is not seen with this condition and an EEG is expected to be normal (of course a patient can have a combination of epileptic and no epileptic seizures).

NES is elated with the emotional disorders of the brain. It is assumed that the patient has some underlying unresolved emotional conflict and it is brought out with a physical manifestation resembling a seizure attack.

Severe emotional trauma, especially during childhood, is thought to be an important cause for NES. Childhood abuse especially sexual in nature committed by the father towards a daughter is a commonly blamed, however this cannot be the only cause as this condition is seen in non abused women and also in men.

An experienced physician like a neurologist (including epileptologist) or psychiatrist can generally make this diagnosis by the history itself. And actually witnessing this episode by these professionals further facilitated the diagnosis.

The NES episodes are usually bizarre appearing, there is no particular pattern for their episodes. Epileptic seizures are kind of stereotypical for a particular patient, means the duration or how exactly the seizure manifests in one patient do not vary a lot of from seizure to seizure. But with NES there could be marked difference from one seizure to another.

Other features that are suspicious for psychogenic seizure include;

• Bicycling movements of the legs
• Eyes closed during seizure than being open
• A tongue bite involving the tip of it rather than the sides
• Absence of bowel or bladder incontinence
• Attention seeking behaviors (episodes intensify when you watch them)

This diagnosis can be done clinically many times but not always. Frontal lobe epilepsy may sometimes look like a pseudo seizure. EEG is often necessary especially a prolonged recording like ambulatory EEG or video EEG monitoring. A serum prolactin level might help too. After a major seizure episode prolactin level in the blood may rise but it is not a fully reliable test.

A CT or MRI sometimes necessary but if the diagnosis of PNES is certain then they are not necessary.

AED (antiepileptic drugs) are not going to help psychogenic seizure patients as they do not have epileptic seizures. They need counseling & psychotherapy. If psychiatric problems like depression, bipolar, anxiety etc are there they need to be treated appropriately.