Summary about Disease
Psychogenic Non-Epileptic Seizures (PNES), also known as Dissociative Seizures or Functional Seizures, are seizure-like events that resemble epileptic seizures but are not caused by abnormal electrical activity in the brain. They are a manifestation of psychological distress, often related to past trauma, anxiety, or other mental health conditions. While the physical manifestations can be very similar to epileptic seizures, the underlying cause is psychological rather than neurological.
Symptoms
Symptoms of PNES can vary widely but often include:
Convulsions or shaking episodes
Staring spells
Unresponsiveness
Loss of awareness
Changes in breathing or heart rate
Crying or screaming
Pelvic thrusting
Side-to-side head movements
Memory problems following the event
Fatigue after the event Symptoms often vary between episodes.
Causes
PNES are not caused by neurological issues. The underlying causes are psychological:
Trauma: A history of physical, sexual, or emotional abuse is a common contributing factor.
Mental Health Conditions: Anxiety disorders, depression, post-traumatic stress disorder (PTSD), and personality disorders are frequently associated with PNES.
Stress: Significant life stressors or ongoing stress can trigger these seizures.
Dissociation: PNES can be a manifestation of dissociation, a mental process where a person feels detached from their body, emotions, or surroundings.
Unresolved Emotional Conflicts: Internal conflicts or suppressed emotions can sometimes manifest as physical symptoms like PNES.
Medicine Used
PNES are not treated with anti-epileptic drugs (AEDs) as they are ineffective since the seizures are not caused by abnormal brain electrical activity. Treatment focuses on addressing the underlying psychological issues. Common treatments include:
Psychotherapy: Cognitive Behavioral Therapy (CBT), Trauma-Focused Therapy, Dialectical Behavior Therapy (DBT), and psychodynamic therapy can help individuals process trauma, manage anxiety, and develop coping mechanisms.
Medication: While AEDs are not used, medications may be prescribed to treat co-existing conditions like anxiety, depression, or PTSD. These might include SSRIs, SNRIs, or other antidepressants or anti-anxiety medications.
Psychiatric Care: Consultation with a psychiatrist is essential for diagnosis and management of co-occurring mental health conditions, medication management, and overall treatment planning.
Is Communicable
No, PNES are not communicable. They are not caused by an infectious agent and cannot be transmitted from one person to another.
Precautions
Precautions focus on safety during an event and preventing future episodes:
During an Event: Protect the individual from injury by clearing the area around them, gently guiding them away from danger, and preventing them from hitting their head. Do not restrain them or put anything in their mouth.
Education: Educate family members, caregivers, and the individual about PNES to reduce fear and misunderstanding.
Stress Management: Implement stress-reduction techniques such as mindfulness, meditation, and exercise.
Adherence to Treatment: Follow through with psychotherapy and any prescribed medication regimens.
Trigger Identification: Work with a therapist to identify and manage triggers that may lead to PNES episodes.
Support Systems: Build a strong support system through family, friends, or support groups.
How long does an outbreak last?
PNES is not an "outbreak" like an infectious disease. The duration of the condition varies significantly from person to person. Some individuals may have occasional episodes triggered by specific events, while others may experience them more frequently over an extended period. The "length" of the condition depends on several factors:
Underlying Psychological Issues: How well the underlying trauma, anxiety, or other mental health conditions are addressed.
Treatment Adherence: How consistently the individual engages in therapy and follows medication regimens.
Coping Skills: The effectiveness of the coping mechanisms developed to manage stress and triggers.
Support System: The strength and stability of the individual's support network. Some individuals may achieve complete remission of PNES with appropriate treatment, while others may experience intermittent episodes throughout their lives.
How is it diagnosed?
Diagnosis of PNES typically involves a combination of assessments:
Detailed Medical History: A thorough review of the individual's medical and psychiatric history, including any history of trauma, anxiety, or other mental health conditions.
Physical and Neurological Examination: To rule out any underlying neurological causes for the seizures.
Video-EEG Monitoring: This is the gold standard for diagnosis. It involves continuous monitoring of brain activity (EEG) while simultaneously recording video of the individual. This allows doctors to determine if seizure-like events are associated with abnormal electrical activity in the brain (epileptic seizures) or not (PNES).
Psychological Assessment: A psychological evaluation to assess for underlying mental health conditions, trauma, and coping mechanisms.
Ruling Out Other Conditions: Doctors will also rule out other medical conditions that can mimic seizures.
Timeline of Symptoms
The timeline of PNES symptoms is highly variable.
Onset: Can start at any age, though is more common in adolescents and adults.
Triggers: Episodes may be triggered by identifiable stressors, emotional distress, or trauma reminders. Sometimes there is no obvious trigger.
During an Episode: The seizure-like activity can last from a few seconds to several minutes.
Post-Episode: Individuals may experience fatigue, confusion, muscle aches, or headaches after an event. The duration of these post-episode symptoms varies.
Long-Term: Without treatment, the frequency and severity of PNES can persist for months or years. With effective treatment, the frequency and severity can be significantly reduced.
Important Considerations
Misdiagnosis: PNES are often misdiagnosed as epilepsy, leading to inappropriate treatment with anti-epileptic drugs.
Co-occurring Conditions: PNES often co-occurs with other mental health conditions, such as anxiety, depression, and PTSD. Addressing these conditions is crucial for successful treatment.
Stigma: There is significant stigma associated with PNES, which can prevent individuals from seeking help. Education and awareness are essential to reduce stigma.
Treatment is Essential: While PNES are not caused by neurological abnormalities, they are a real and debilitating condition that requires appropriate psychological treatment. Ignoring the condition can lead to worsening symptoms and impaired quality of life.
Collaboration: Effective treatment requires a collaborative approach involving neurologists, psychiatrists, psychologists, and other healthcare professionals.