Psych Series #8

Psych Series #8: Psychogenic Non-Epileptic Seizure (PNES)

Recently we have noticed an increase in the number of medical emergencies we are responding to at work for "seizure activity." A friend said to me the other day, "How can there be so many people having seizures in one facility? In my entire life, I've only known one person who had a seizure, yet you are seeing these girls have them on an almost daily basis!!" In response, I have chosen to bring you all some general information on epileptic and non-epileptic seizure disorders. Happy reading!

What is a seizure? In general a seizure is "a temporary loss of control, often with abnormal movements, unconsciousness, or both." Epileptic seizures are caused by "a sudden, abnormal electrical discharge from the brain." Other causes of seizures can include brain injury, alcohol withdrawal, extremely high fever, lead poisoning, infections involving the brain, brain tumors, or withdrawal from certain medications.

Epileptic Seizures

• Can be caused by any process that disrupts the stability of the neuronal cell membrane.
• Involves 3 classifications - genetic, acquired, or idiopathic.
  
• Seizures are also classified according to age of onset, cause, area of origin in the brain, EEG abnormalities, and clinical symptoms during seizure activity.

Types of Seizures in Epilepsy

1. Partial - focal or local

• Motor activity or involuntary movements are generally limited to an upper extremity, entire limb, and/or one side of the face.
• Sensory phenomena may develop such as numbness or tingling to the affected area.
• Autonomic system stimulation results in epigastric sensations, pallor, sweating, "goose bumps", rapid heart beat, and rapid breathing.
• May produce an "aura" such as a strange noise, smell, or visual disturbances.
• May exhibit "automatisms" or automatic behaviors such as lip-smacking, chewing, patting a part of the body, or picking at clothing.

2. Generalized

• Lead to a loss of consciousness.
• May be convulsive or nonconvulsive.
• Manifestations involve both hemispheres of the brain.
• Include: Absence, Myoclonic - sudden, uncontrolled jerking movements, Clonic - rhythmic muscular contraction and relaxation, Tonic - an abrupt increase in muscle tone and contraction, Tonic-Clonic, Atonic - total loss of muscle tone.

Psychogenic (non-epileptic) Seizures

• May resemble epileptic seizures, but do not involve abnormal electrical discharges in the brain.
• Are stress-related or "emotional."
• Are frequently misdiagnosed.
• Patients may exhibit different movements with each seizure.

Diagnosis

• EEG (electroencephalogram) with video monitoring - recording a patient for several hours to several days until seizure activity occurs.

Causes

• Emotional, stress-induced, and can result from traumatic psychological experiences.

Treatment

• Because PNES is a psychiatric condition, treatment mainly involves mental health professionals rather than a neurologist.
• Some treatments include:
• Psychotherapy
• Stress-reduction techniques like relaxation and biofeedback training
• Personal support to help with coping during treatment

So, if you or a loved one suffer from seizures and antiepileptic medications don't seem to help control them, evaluation for PNES may be indicated. Please remember, PNES are real seizures. Though they stem from emotional or stress-related issues, they are not "faked" events. Individuals with PNES need the same TLC and understanding we provide for epileptic patients.

As always, I wish you peace, love, and happiness this Spring!

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