Understanding Non-Epileptic Seizures: Causes, Symptoms, and Management

When most people think of seizures, they immediately associate them with epilepsy. However, not all seizures are epileptic. Non-epileptic seizures (NES), also known as psychogenic non-epileptic seizures (PNES), are real, physical episodes that resemble epileptic seizures but are not caused by abnormal electrical activity in the brain. Instead, these events are often triggered by psychological or emotional distress.

What Are Non-Epileptic Seizures?

Non-epileptic seizures are sudden, involuntary changes in movement, behavior, sensation, or consciousness that look like epileptic seizures. However, when brain activity is monitored during an NES, no epileptic discharges are seen. This distinguishes NES from true epilepsy.

NES is classified as a functional neurological disorder, meaning the nervous system is structurally intact, but it doesn’t work properly. It's not a sign of malingering or faking; the symptoms are real and can be highly disruptive.

Common Causes of Non-Epileptic Seizures

NES is often linked to:

Emotional trauma (e.g., abuse, PTSD)

Stress, anxiety, or depression

Personality or dissociative disorders

Chronic pain or fatigue syndromes

It’s also more common in individuals with a history of psychological distress, including those who’ve experienced childhood trauma.

Symptoms of Non-Epileptic Seizures

NES can mimic various forms of epileptic seizures, which makes diagnosis challenging. Symptoms may include:

Convulsions (shaking or jerking movements)

Sudden collapse

Unresponsiveness

Crying or screaming

Twitching or stiffening

Loss of consciousness

One unique feature is that NES episodes may last longer than epileptic seizures and sometimes occur in specific emotional or social contexts.

How Is NES Diagnosed?

The gold standard for diagnosing NES is video-EEG monitoring. This test records electrical activity in the brain while simultaneously capturing video of the patient’s behavior. If no abnormal brain activity is detected during a seizure-like event, a diagnosis of NES is likely.

Other assessments may include:

Psychological evaluation

MRI or CT scans to rule out structural issues

Blood tests for metabolic imbalances

Treatment Options

Since NES is usually related to psychological factors, treatment is primarily psychological rather than neurological.

Cognitive Behavioral Therapy (CBT): Helps patients manage underlying psychological issues, especially anxiety and trauma.

Psychotherapy or trauma-focused therapy: Addresses root emotional conflicts.

Stress management techniques: Mindfulness, meditation, or yoga may reduce episode frequency.

Medication: Antidepressants or anxiolytics may be used, but anti-epileptic drugs are usually not effective unless epilepsy is also diagnosed.

Living with NES

A correct diagnosis can be life-changing. Many individuals with NES have previously been misdiagnosed with epilepsy and treated with unnecessary medications. With proper therapy and support, many people can reduce or even eliminate their seizures altogether.

Support groups and educational resources can also help patients and families better understand NES and reduce stigma.

Conclusion

Non-epileptic seizures are complex and often misunderstood. While they may resemble epileptic events, their causes and treatments differ significantly. Early recognition, accurate diagnosis, and psychological support are essential for long-term recovery. If you or someone you know is experiencing seizure-like episodes that don’t respond to epilepsy medications, it may be time to explore the possibility of NES and seek help from a neurologist or mental health specialist.

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