Everything you need to know about PNES (Psychogenic Non-Epileptic Seizures

What are seizures? 

Seizures are sudden behavioral disruptions that affects a person’s feelings, emotions, level of consciousness. Following the latter mentioned symptoms they also cause a sort of involuntary movement in a patient’s body. 

Seizures are commonly triggered by unsuitable medication, stress, anxiety, insomnia, substance abuse etc. While seizures can be threatening to witness and experience, they are not untreatable. The only possible downside associated with treatment of seizures is their misdiagnosis. 

There is no dearth of popular confusion vis-a-vis the point of differentiation between an epileptic seizure and a non-epileptic one. While overlapping symptoms might be the reason behind such confusion, studies have concluded that epileptic seizures might stem from some inherent oddity in the functioning of the brain. As opposed to the latter, non-epileptic seizures are largely triggered by psychological factors.

What are Psychogenic Non-Epileptic Seizures?

Psychogenic non-epileptic seizures are characterized by sudden changes in levels of consciousness, involuntary movement of the limbs and an unusual lack of awareness.

Often confused with epileptic seizures, these seizures actually stem from basal psychological issues. While there are certain conspicuous similarities between the symptoms of epileptic and non-epileptic seizures, the primary differentiation between the two is the underlying cause that triggers the two.

While epileptic seizures can be attributed to some anomaly in the very functioning of a patient’s brain, psychogenic non-epileptic seizures, as research suggests are a byproduct of underlying psychological stressors like psychiatric disorders and sometimes even substance abuse.

How are psychogenic non-epileptic seizures different from epileptic seizures? 

While epileptic seizures have most of their characters acting in a sort of synchronized manner, PNES involves too many variables. The symptoms in case of psychogenic non-epileptic seizures are less predictable. The latter might vary in intensity and their subsequent progression.

While epileptic seizures have a shorter duration of about a minute or two, non-epileptic seizures might last longer than that.

People tend to keep their eyes open during epileptic seizures while they might be forced shut during a non-epileptic seizure 

People rarely talk or make a sound during an epileptic seizure. The same however might change in case of non-epileptic seizures where signs of vocalisation are not exactly uncommon.

Epileptic seizures conclude gradually while non-epileptic seizures might abruptly come to a halt.

What are the causes of PNES? 

Contrary to popular belief the root cause of PNES is not some irregularity in the brain or some vascular malformation. The cause of these seizures in fact acts as the key differentiation between them and epileptic seizures. While the latter, as a matter of fact, are caused by irregularities in the functioning of brain, non-epileptic seizures largely stem from intrinsic psychological discomforts.

While a concrete physical cause behind the occurrence of these seizures is yet to be disclosed, some psychological causes have been popularly acknowledged as potential triggers to these seizures. 

Common psychological discomforts that have been popularly identified as primary contributors to the emergence of PNES are as follows – 

●     PTSD

●     Domestic stress

●     Anxiety 

●     Deficit of attention

●     Drug dependence 

●     Follow up stressors stemming from aggression, withdrawal and anger. 

When to see a doctor?

Psychologists, psychiatrists and behavioural therapists are some of the common mental health providers approached by patients of PNES. Following are the signs that must not be taken for granted when someone is getting a psychogenic non-epileptic seizure:

●     Prolonged duration of a seizure.

●     Body doesn’t return to normalcy even after the seizure stops.

●     Unusual body temperatures.

●     If the patient has an underlying illness like diabetes.

●     If the patient is expecting.

While it might seem like a possible resolve to not see a doctor at all in case of mild symptoms, it's not exactly the smartest choice. Mild symptoms might fail to make the dangers of seizures less apparent but avoidance of the same should not be an option. Getting even a mild seizure outside the protective peripheries of one’s home can be extremely dangerous. Seizures experienced while driving for example can lead to severe accidents.

What are the available treatments for PNES?

Following is a list of methods undertaken by medical professionals to help treat PNES:

1.    CBT or Cognitive Behavioral Therapy is a common treatment for a variety of psychological disorders like anxiety, depression etc. This is a fairly common method of treatment when it comes to treating patients of PNES. This therapy educates the patient in channeling their emotions in a better manner so as to have a healthier response to unprecedented stressful situations.

2.    Prolonged Exposure Psychotherapy is a type of CBT that is concerned with working upon or with primary stressors that cause psychological changes which then ultimately lead to seizures. This method of treatment adopts a step-by-step approach to recovery.

3.    Interpersonal Therapy involves a conversational solution to a patient’s emotional difficulties. Here a therapist helps the patient talk about and through her or his emotional discomforts. 

4.    Mindfulness or meditation is another recommended treatment where a patient comprehends and familiarizes herself or himself with how she or he perceives various stimuli. This method of treatment helps patients in distancing themselves from harmful thought patterns.

5.    Family therapy is suited for families where children or adolescents suffer from PNES. Here the treatment is not limited to the patient but is extended to the patients’ family in the form of education. The family is acquainted with symptoms of PNES and prepared to deal with the same.

What does recovery look like for people with PNES?

Recovery might look different for different people. While a lot of people exhibit visible recovery right after their diagnosis, it might take a little longer for others to make the same level of progress. 

For people receiving psychological treatment/therapy, keeping in touch with one’s mental health provider can really help. Monitoring behavioral improvements on a personal level can also prove beneficial.

There is a fair share of patients of PNES who have been observed to recover relatively faster. This group includes adolescents, people with a smaller number of experiences of seizure and lastly people who tend to experience only mild symptoms.

Transparency is a lesser acknowledged but fairly crucial factor when it comes to treatment. Patients and their families must not hesitate in presenting the patients' medical history or records. An honest and detailed account given by any witness of the seizure of what it looked like can also greatly help the medical professional reach to a better conclusion.

Sources:

 https://www.epilepsy.com/diagnosis/imitators-epilepsy/psychogenic-nonepileptic-seizures

https://www.medicalnewstoday.com/articles/322016#outlook

https://www.osfhealthcare.org/blog/dangers-of-seizures/

https://www.mayoclinic.org/diseases-conditions/seizure/symptoms-causes/syc-20365711