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Psychogenic non-epileptic seizures

 

 
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Psychogenic non-epileptic seizures
 
 
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Psychogenic non-epileptic seizures are a manifestation or a form of conversion disorder
Conversion disorder

Conversion disorder is a condition where patients present with neurological symptoms such as numbness, paralysis, or Psychogenic non-epileptic seizures, but where positive physical signs of hysteria can be found....
. They take many forms, and particularly can mimic any sort of epileptic seizure; they are distinguished from epilepsy
Epilepsy

Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizure s. These seizures are transient signs and/or symptoms of abnormal, excessive or synchronous neuronal activity in the brain....
 only in that they are not associated with abnormal, rhythmic discharges of cortical neuron
Neuron

Neurons are responsive cell in the nervous system that process and transmit information by electrochemical Signal . They are the core components of the brain, the vertebrate spinal cord, the invertebrate ventral nerve cord, and the peripheral nerves....
s. The condition is not benign; people have broken bones, crashed automobiles, bitten off parts of their tongue, and even died from injuries sustained during non-epileptic seizures.

An older term, pseudoseizures, is deprecated.






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Psychogenic non-epileptic seizures are a manifestation or a form of conversion disorder
Conversion disorder

Conversion disorder is a condition where patients present with neurological symptoms such as numbness, paralysis, or Psychogenic non-epileptic seizures, but where positive physical signs of hysteria can be found....
. They take many forms, and particularly can mimic any sort of epileptic seizure; they are distinguished from epilepsy
Epilepsy

Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizure s. These seizures are transient signs and/or symptoms of abnormal, excessive or synchronous neuronal activity in the brain....
 only in that they are not associated with abnormal, rhythmic discharges of cortical neuron
Neuron

Neurons are responsive cell in the nervous system that process and transmit information by electrochemical Signal . They are the core components of the brain, the vertebrate spinal cord, the invertebrate ventral nerve cord, and the peripheral nerves....
s. The condition is not benign; people have broken bones, crashed automobiles, bitten off parts of their tongue, and even died from injuries sustained during non-epileptic seizures.

An older term, pseudoseizures, is deprecated. While it is correct that a non-epileptic seizure may resemble an epileptic seizure, pseudo
Pseudo

The prefix pseudo is used to mark something as false, fraudulent, or pretending to be something it is not:pseudo-scholarship * pseudoscience...
 can also connote "false, fraudulent, or pretending to be something that it is not." Non-epileptic seizures are not false, fraudulent, or produced under any sort of pretence.

Diagnosis

Confounding neurologists
Neurology

Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the Central nervous system, Peripheral nervous system, and autonomic nervous systems, including their coverings, blood vessels, and...
 and other physician
Physician

A physician, medical practitioner, doctor of medicine, or medical doctor practices medicine, and is concerned with maintaining or restoring human health through the study, diagnosis, and treatment of disease and injury....
s, psychogenic non-epileptic seizures are frequently misdiagnosed as epilepsy
Epilepsy

Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizure s. These seizures are transient signs and/or symptoms of abnormal, excessive or synchronous neuronal activity in the brain....
; less frequently, the reverse is true. Misdiagnosis means that appropriate treatments are not received by the patient. In addition, the former misdiagnosis is dangerous because it can result in administration of unnecessary (and even potentially harmful) medication; the latter because a person with epilepsy is not correctly treated with medication that could help them. Statistics on the prevalence
Prevalence

In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population....
 of these misdiagnoses are not available.

Certain features suggest the presence of PNES, including the presence of tears
Tears

Tears are the liquid product of a process of lacrimation to clean and lubricate the eyes. The word lacrimation may also be used in a medical or literary sense to refer to crying....
, which are uncommon in epileptic seizures, and a tendency for attacks to occur when other people are present, but not while sleeping or alone.

Inpatient hospitalization for long term video-EEG monitoring
Long-term video-EEG monitoring

Long-term video-EEG monitoring, also known as video telemetry, is a diagnostic technique used in certain patients with epilepsy or seizures. It involves the inpatient hospitalization of the patient for a period of time, typically days to weeks, during which they are continuously monitored and recorded with a video camera and an electroenceph...
 is a costly but effective way to distinguish them from epileptic seizures. They tend not to respond to anticonvulsant medications. Also, many persons with epilepsy experience non-epileptic seizures as well; finding evidence of one does not rule out the presence of the other.

Many physicians measure serum prolactin
Prolactin

Prolactin or Luteotropic hormone is a peptide hormone primarily associated with lactation. In breastfeeding, the act of an infant suckling the nipple stimulates the production of prolactin, which fills the breast with milk via a process called lactogenesis, in preparation for the next feed....
 levels in patients who may have non-epileptic seizures, because serum levels of prolactin are often elevated just following an epileptic seizure, returning to normal within 15 minutes. Still, a negative prolactin does not rule out epileptic seizures (Ahmad & Beckett 2004). Also... individuals with non-epileptic seizures may have elevated prolactin levels for other reasons, including intercurrent epilepsy and medication side effects.

Treatment


The patient with psychogenic non-epileptic seizures is sometimes found to give a history of childhood physical abuse
Physical abuse

Physical abuse is abuse involving contact intended to cause feelings of intimidation, pain, injury, or other physical suffering or harm.Basic forms include:...
 or sexual abuse
Sexual abuse

Sexual abuse, also referred to as molestation, is the forcing of undesired sexual acts by one person upon another. The offender is referred to as a molester/molestor/ abuser/sexual abuser....
 or other severe emotional trauma
Psychological trauma

Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. When that trauma leads to posttraumatic stress disorder, damage may involve physical changes inside the brain and to brain chemistry, which affect the person's ability to cope with Stress ....
. (Betts, 1997.)

See also

  • Non-epileptic seizures
    Non-epileptic seizures

    Non-epileptic seizures are Paroxysmal attacks events that mimic an epileptic seizure but do not involve abnormal, rhythmic discharges of cortical neurons....
  • hystero-epilepsy
    Hystero-epilepsy

    Hystero-epilepsy is an alleged disease "discovered" by 19th-century French neurologist Jean-Martin Charcot. It is considered a famous example of iatrogenic artifact, or a disease created by doctors....
  • Functional Neurological Deficit
    Functional Neurological Deficit

    Many patients present to neurologists with a variety of symptoms for which there is no current organic or psychological explanation despite extensive investigation....
  • Somatoform disorder
    Somatoform disorder

    Somatoform disorder is characterized by physical symptoms that mimic disease or injury for which there is no identifiable physical cause or physical symptoms such as pain, nausea, Clinical depression, and dizziness....


External links

  • This article has statistical research data which suggests that non-epileptic seizures can be dramatically improved with psychotherapy.
  • . A slightly more technical article aimed at health professionals.