Non-epileptic (NC) seizures, or dissociative seizures, can resemble epileptic seizures but are not caused by abnormal electrical activity in the brain. This guide will help you understand what non-epileptic seizures are, what causes them and how they are diagnosed. and how they can be treated.
Description of dissociative seizures
There are many different types of seizures and they can occur for many different reasons. Epilepsy and epileptic seizures are explained below.
Seizures that are not due to epilepsy are sometimes referred to as "non-epileptic seizures." They may have a physical cause, such as B. low blood sugar (hypoglycaemia), or they may be related to your heart function. Or they can have a psychological cause. The most common type of non-epileptic (NC) seizures are dissociative seizures (see below).
You may be looking at this information if you or someone you know has been diagnosed with NES. It can help you identify different types of seizures and why they might be happening to you or someone you know.
What causes epileptic seizures?
Epileptic seizures are caused by a disturbance in the brain's electrical activity (which is why they always start in the brain). Our brain controls the way we think, move and feel by relaying electrical messages from one brain cell to another. If these messages are interrupted or too many messages are sent at once, an epileptic seizure occurs.
What happens to the person during theConvulsionit depends on where in the brain the seizure activity occurs and what that part of the brain is doing.
About 1 in 5 people (20%) diagnosed with epilepsy who are subsequently evaluated in specialized epilepsy centers have CNS
This may be partly because epilepsy and NES look very similar and can affect people in similar ways. However, the difference between epileptic and non-epileptic seizures lies in their underlying cause.
Non-epileptic seizures (NES) are not caused by abnormal electrical activity in the brain and are therefore distinct from epilepsy. They can have many different causes.
dissociative seizures
Some NES are caused by mental or emotional processes rather than a physical cause. These types of seizures can occur when a person's response to painful or difficult thoughts and feelings physically affects them. These are called dissociative seizures.
Dissociative seizures used to be called “pseudo-icures.” This name isn't helpful because it suggests the person isn't having "real" seizures or that their seizures are intentionally "fake."
Dissociative seizures occur unconsciously, meaning the person has no control over them and does not trigger them. This is the most common type of NES.
Dissociative seizures are sometimes referred to as non-epileptic seizures. People who have non-epileptic seizures may be referred to as "non-epileptic seizure disorder" (NEAD).
These terms are not always helpful as they describe the condition by saying what it is not rather than what it is.
The new name, dissociative seizures, makes more sense because it doesn't describe the seizures in terms of epilepsy. It's also recognized by the World Health Organization (meaning it's included in the International Classification of Diseases, which is a list of all known diseases and conditions).
However, it can be confusing as doctors sometimes use the terms NES or NEAD when discussing dissociative seizures. Other names for dissociative seizures are functional seizures or psychogenic seizures.
What Causes Dissociative Seizures?
We all react differently to scary or stressful situations. When we are scared we can experience physical symptoms such as a rapid heartbeat or a feeling of sweating. When we are sad we can cry. So how we feel emotionally can sometimes provoke a physical response.
An extremely scary or upsetting experience can be emotionally difficult for some people because they feel they are not conscious of their feelings.
In some cases, we will unconsciously hide or "repress" the memory of these experiences. These memories can stay hidden forever and we may never remember the events that happened.
For some people, memories of these painful past events may suddenly surface or "invade" their mind or consciousness. This can happen during an emotional or stressful situation, or when something in the environment is unconsciously triggering a distressing memory.
Dissociative seizures can occur as a cutting mechanism to prevent bad memories from being relived. The person disconnects (or dissociates) their feelings about the experience because it's too hard to bear. The seizure occurs because your emotional response produces a physical effect.
These seizures are an unconscious response, meaning they are not intentional and the person has no control over them.
One way to describe this is to compare it to "domestic deafness". This is the experience of focusing so much on something that we don't notice when someone is talking to us. It can feel like turning the volume down to drown out everything around you so you can focus. Dissociative seizures are like the body's method of "drowning" a frightening or painful memory before it enters our minds.
Every experience we have, good or bad, can have a profound and lasting impact on us, and each of us has our own way of dealing with it. Dissociative seizures are often caused by traumatic events such as:
- serious accidents
- Severe emotional upheaval (such as the death of a loved one)
- psychological stress (e.g. divorce)
- difficult relationships
- physical or sexual abuse
- be mistreated.
It can be difficult to pinpoint the cause of a person's dissociative seizures. For some, they begin right after a specific event. For others, they may start years later or suddenly for no apparent reason. Once dissociative seizures have started, they can be triggered or triggered when the person is stressed or anxious. Or they appear spontaneously in situations that are neither stressful nor frightening. Sometimes even the fear of having a seizure can trigger a seizure.
Finding the original event that caused the dissociative seizures to begin can help identify a way to treat the seizures. But that's not always possible, and it can be difficult to talk about traumatic or difficult events.
Seizures caused by a delayed response to a very stressful event or situation, e.g. B. in a war or a disaster, are a reaction to post-traumatic stress disorder (PTSD), a condition that sometimes occurs after a traumatic event. . During the seizure, the person may cry, scream, or have flashbacks (sudden, vivid memories of the event). You may not remember the seizures afterwards.
What are the symptoms?
Although dissociative seizures begin as an emotional response, they have a physical effect. Attack characteristics may include palpitations (feeling your heartbeat), sweating, dry mouth, and hyperventilation (excessive breathing).
Some characteristics of dissociative seizures are very similar to epileptic seizures. These physical characteristics can include loss of consciousness, loss of feeling, and loss of control over body movements.
Who Has Dissociative Seizures?
Dissociative seizures can affect anyone at any age, although certain factors make dissociative seizures more likely. Dissociative seizures are:
- more common in women
- tend to start in young adults
- It's more likely to happen to people who have suffered an injury or illness, or who have had severe emotional disturbances or stressful life events
- more common in people with other psychiatric conditions (such as depression, anxiety, personality disorders, or people who harm themselves).
How Are Dissociative Seizures Diagnosed?
If you have seizures, your doctor will usually refer you to a specialist for a diagnosis. A neurologist (a doctor who specializes in the brain and nervous system) is usually seen to check for epileptic seizures. Or they will refer you to a psychiatrist or psychologist (since dissociative seizures are generally classified as a psychiatric disorder).
It may be easier for doctors to first try to rule out possible physical causes, including epilepsy. This affects the types of tests you can run.
Dissociative seizures can be difficult to diagnose because they can resemble epileptic seizures. There are no symptoms that clearly distinguish dissociative seizures from epileptic seizures.
Take a personal story
testused to find the cause of seizures alone cannot confirm a diagnosis. However, a "personal history" can help identify the cause of your seizures. This includes looking at:
- Your neurological history (about your brain and nervous system and their development)
- Your mental development and mental health, including whether you have depression or other psychiatric conditions, or a history of exposure to stress and trauma
- if there is a family history of depression or other illnesses
- history of your seizures, e.g. B. when they started and when they occur
- if you have been diagnosed with epilepsy but your seizures have never been controlled with antiepileptic drugs.
what happens in the event of an attack
Asking what happens during a seizure can be helpful in finding the cause. If you don't remember your seizures, you can bring someone who saw your seizures.
The specialist may ask about:
- when your seizures occur
- if you get a warning before a seizure occurs
- what happens to you during the seizure. If you don't remember, a witness can help describe what is happening to you.
- how long do seizures last
- what, if anything, do you remember about the seizure afterwards
- how you feel afterwards and how long it takes you to recover.
medical evidence
Some tests are used to rule out other causes of seizures, including epilepsy.
- Medical tests and blood tests can be used to check your general health and determine if your seizures have a physical cause, such as diabetes.
- brain scanssuch as CT (computed tomography) or MRI (magnetic resonance imaging) are used to create a picture of your brain. This may indicate a physical cause for epileptic seizures but would not generally be helpful in diagnosing dissociative seizures.
- EEEG (electroencephalogram)records the electrical activity of the brain. It is commonly used to check if seizures are caused by abnormal brain activity and helps diagnose epilepsy. Dissociative seizures are not caused by changes in brain activity.
- With video telemetry, an EEG is created and recorded on video at the same time. This compares what a person is doing to what is happening in their brain during the seizure and can often tell the difference between epileptic and dissociative seizures. It might helpDiagnose epilepsy(when your brain activity changes during a seizure) or diagnose dissociative seizures (when your brain activity does not change during a seizure).
If tests don't reveal a neurological or physical cause for your seizures, and your specialist thinks they may be dissociative seizures, you may be referred to a psychiatrist or psychologist for a diagnosis.
treatment options
Treatment may depend on the cause of your seizures and your medical history. Your specialist can talk to you about what treatment options might be helpful.
medicine
Seizures that are not epileptic are not controlledAntiepileptics (AEDs).
If you are already taking antiepileptic drugs, for example if you have been diagnosed with epilepsy, your specialist may suggest that you gradually taper them off. If you have dissociative seizures and epilepsy, you will usually continue to take AEDs for your seizures.
If you also have anxiety or depression, your doctor can talk to you about whether other medications, such as antidepressants, may help.
Other forms of treatment
Psychotherapy is the recommended treatment for dissociative seizures. Psychotherapy is the term for a group of different "talking" therapies (treatments). Mental health professionals, including psychiatrists and psychologists, are trained in various forms of psychotherapy.
Cognitive behavioral therapy (CBT) is often recommended. CBT examines how you think about things, how it affects you physically and emotionally, and how it affects what you do (your behavior). By changing the way you think about things, how you think about yourself, other people and the world around you, you can change your behavior. CBT tends to focus on how things are affecting you in the present and ways you can see current situations more positively and deal with stressful events.
CBT can last for several months or more as it may take some time before you feel comfortable talking about your experiences and feelings.
see more abouttreatment of epilepsy.
How are you doing with your diagnosis?
Being diagnosed with an illness can trigger many different emotions and affect many parts of your life. You may be relieved to learn what is causing your seizures. Or you may find it difficult to accept, especially if you were previously diagnosed with epilepsy and are now diagnosed with dissociative seizures.
Being diagnosed with dissociative seizures can also be quite frightening or troubling since there is sometimes a stigma attached to psychiatric illness. It can be helpful to understand that dissociative seizures can be your body's natural response to stressful situations.
There is no "right" way to think about your diagnosis, but being able to accept it can help improve seizure control.
You can call our confidential numberHotlineto talk about your diagnosis and how it makes you feel.
Other types of non-epileptic seizures
There are other types of ENS and these can be divided into two types: those with an organic cause and those with a psychological cause.
NES that have an organic cause
These seizures have a physical (body-related) cause. These include fainting (syncope) and seizures with metabolic causes such as diabetes.
Because organic NES have a physical cause, they can be diagnosed and the underlying cause found relatively easily. For example, a fainting spell caused by a physical problem with the heart can be diagnosed. In these cases, the seizures stop when the underlying cause can be treated.
NES that have a psychological cause
In addition to dissociative seizures, there are other types of seizures that have a psychological cause:
- Panic attacks can occur in frightening situations, when recalling past frightening experiences, or in a situation that the person expects to be frightening. Panic attacks can cause sweating, palpitations (feeling the heartbeat), tremors, and shortness of breath. The person may also lose consciousness and tremble.
- False seizures mean that the person has some degree of conscious control over them. An example of this is when seizures are part of Munchausen syndrome, a rare psychiatric condition in which the person is driven by the need to undergo medical evaluation and treatment.
Regardless of the type of seizure you have, you may want to talk to someone about your diagnosis and how you feel about it.
Call our confidentialHotlineif you wanna talk
Living with non-epileptic seizures
First aid
the generalFirst aidThe guidelines for dissociative seizures are the same as for epileptic seizures:
- Protect person from injury or harm - Do not move unless you are in danger
- If he falls, put something soft under his head to protect him
- allow, not limit, or restrict the seizure
- stay with them until they recover.
If possible, keep a normal routine
For some people, NES can interrupt their daily lives or make them want to avoid activities when they have a seizure. However, studies show that maintaining as normal a routine as possible and trying to participate in activities with other people can help. This can help prevent isolation and anxiety, which can increase the likelihood of seizures.
Treating NES may work best when someone is active in life, which includes working, studying, or participating in other meaningful and fulfilling activities.
If you work, your employer is responsible for protecting you and other employees at work. To do this, they may need to be aware of any medical conditions that affect you at work, including NES.
Your employer may need to conduct a "risk assessment" to determine if your condition could affect work safety.
See our information belowWork.
Financial Aid and Benefits
Depending on how your seizures are affecting you, you may be able to apply for financial help. Regardless of the cause, seizures can affect different areas of some people's lives.
know more about itwhat help is available.
Rules of conduct for dissociative seizures
Road traffic rules in the UK are set by theDriver and Vehicle Registration Office (DVLA). You must stop driving and report to the DVLA that you are having dissociative seizures. After three months without seizures, you can apply for a new license.
If seizures are likely to occur while driving, specialist evaluation is also required. These regulations are based on the risks of a seizure while driving.
Visitgov.uk/conducir-condiciones-medicasFor more information.
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seizures and disability
HimEquality Act 2010aims to protect people from discrimination if they have a disability.
A disability is defined as “a physical or mental impairment that significantly and permanently impairs the ability to carry out normal activities of daily living”.
Here, 'significant' means that activities are difficult or time-consuming compared to someone without a disability, and 'long-term' means at least 12 months. 'Activities of daily living' include the ability to move, hear, see, remember and concentrate.
The Gender Equality Act does not contain a list of all recorded disabilities. Although epilepsy is included as a physical disability, dissociative seizures are not. To be protected by the Equality Act you must show that you meet the above definition.
Visit amiHigh-quality consulting serviceMore information on the Equal Treatment Act.
Other Organizations
- STARS (Reliant Syncope and Reflex Anoxic Seizures) (opens in new window)– provides support and information.
- NDF share- Sensitization to functional neurological disorders (FND) and non-epileptic seizure disorders (NEAD).
- Consulting directory– to find a counselor or therapist in your area. Your family doctor or specialist can also refer you to counseling or psychotherapy.
- British Association for Counseling and Psychotherapy– The professional body for practitioners in the UK and has a Register of Trained Therapists.
Information revised as of April 2020