What are they?

Events that look like seizures but are not due to epilepsy are called "nonepileptic seizures." A common type is described as psychogenic (si-ko-JEN-ik), which means beginning in the mind. Psychogenic seizures are caused by subconscious mental activity, not abnormal electrical activity in the brain. Doctors consider most of them psychological in nature, but not purposely produced. Usually the person is not aware that the spells are not "epileptic." The term "pseudoseizures" has also been used (mostly in the past) to refer to these events.

Are they common?

Psychogenic nonepileptic seizures are common. About 20% of the patients referred to comprehensive epilepsy centers for study with video-EEG are found to have nonepileptic seizures. About 1 in 6 of these patients either also has epileptic seizures or has had them, however. These people need different treatment for each disorder. Psychogenic nonepileptic seizures have been more widely recognized during the past several decades. They are most often seen in adolescents and young adults, but they also can occur in children and the elderly. They are three times more common in females.

What do they look like?

The seizures most often imitate complex partial or tonic-clonic (grand mal) seizures. Family members report episodes in which the patient stiffens and jerks. Doctors rarely witness the actual event, so they are drawn toward the diagnosis of epilepsy. Often years can be spent trying to treat the spells as epileptic seizures without success.

How are they recognized?

Doctors have identified certain kinds of movements and other patterns that seem to be more common in psychogenic nonepileptic seizures than in seizures caused by epilepsy. Some of these patterns do occur occasionally in epileptic seizures, however, so having one of them does not necessarily mean that the seizure was nonepileptic. Video-EEG monitoring is the most effective way of diagnosing nonepileptic seizures. The doctor may take steps to provoke a seizure and then ask a family member or friend of the patient to confirm that the event was the same as the usual kind.

Can they be treated?

Psychogenic nonepileptic seizures do not necessarily indicate that the person has a serious psychiatric disorder. The problem does need to be addressed and many patients need treatment. Sometimes the episodes stop when the person learns that they are psychological. Some people have depression or anxiety disorders that can be helped by medication. Counseling for a limited time is often helpful. The person needs to accept the diagnosis (at least as a possibility) and follow through with therapy.

Topic Editor: Orrin Devinsky, M.D.
Last Reviewed:2/11/04