Not all seizures have epilepsy as a cause. Some people experience symptoms which are similar to that of an epileptic seizure but without the unusual electrical activity. When this occurs, it is known as a psychogenic non-epileptic seizure (PNES). These seizures are very real to the person experiencing them, and they have no conscious or voluntary control over them. Outwardly, these seizures resemble epileptic seizure types and can occur at any age. PNES events are believed to be complex physical reactions to significant psychological stresses.
Around 20% – 30% of patients referred to epilepsy centres for uncontrolled seizures are subsequently diagnosed with PNES. If a neurologist suspects that a person is experiencing PNES, they will conduct diagnostic tests to rule out epilepsy. Once it is determined that epilepsy is not the cause then other conditions which resemble seizures will also need to be discounted. This may include investigations to rule out heart disease, stroke, fainting and neuromuscular disorders. If these tests prove negative, then a psychological or psychiatric assessment is recommended in order to diagnose PNES. Unfortunately, because it is not a well-known condition, people can spend many years in the health system before receiving the appropriate diagnosis of PNES. This can be an exhausting and frustrating process, but it is important to find the right diagnosis so that you may begin the right treatment plan.
Factors that may make a person vulnerable to developing PNES can include inherited factors, and difficult early experiences, including trauma. PNES may also start when people face difficulties or trauma in adulthood (e.g. unexpected life events, such as a death, accident, health problems or personal dilemmas).
For some people, a diagnosis of PNES may be a relief because there is no underlying physical cause of their illness. For others, however, the diagnosis can be upsetting because of the stigma that can be associated with psychiatric conditions. Understanding that PNES is a complex reaction to stressful situations and not a conscious act is therefore very important.
Anti-epileptic drugs (AEDs) will not resolve PNES, but treatment for PNES may include psychological therapy and/or medication.