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Epilepsy versus pseudoseizures

I am trying to do a little research on my own because after two neurologists, I have had no help.  I have had a total of three seizures within a year and never any before then.  I had my first seizure in the hospital the day my husband was having a heart attack.  He had been waiting 3 hours to be seen in the ER for severe chest pain.  I was getting extremely worked up making sure he was seen as soon as possible.  We finally got back to the room and I dropped down and had a seizure.  What luck is that.  My husband has a heart attack and I drop down and have a seizure the same exact day?  My husband is in law school full time and I am the money maker right now working 13 hour days supporting the family so right there is a whole bunch of stress.  My second seizure was six months later.  I had lack of sleep and had to entertain a huge family over for Christmas and still work.  I had a few auras in between with nausea but I did not think anything of it.  This second time, I felt the aura coming on and boom I went down.  This third seizure, I had in my sleep and I bit my tongue quite a bit on the side.  My husband thankfully was able to wake me up but I did not know who anybody's names were.  I have had an MRI, CT scan, EEG twice with all of them coming back normal.  They did find a sphenoid wing benign tumor but they all said it was not important and had nothing to do with my seizures.  I was just at my six month mark to drive and boom this happens again.  Now I am at a loss.  I am ready to go to U of M and wait for the 6 month waiting list appointment.  Has anybody experienced stress-related seizures or does this sound more like epilepsy coming on?  I moan slightly but don't do a whole lot of body twitching with my seizures.  Between my husbands heart attacks, medical bills, regular bills, me working 13 hour days all the time in front of a computer and taking care of my children, its got to be the stress.  What are the chances that my husband and I would have a serious medical condition come about on the same day.  Any information would be great. 

 

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Re: Epilepsy versus pseudoseizures

First of all, why do you think they are psuedoseizures? Is that what you were told? Were you put on any meds? Were you given any advice?

Let's say for arguement's sake that you do have "peudo seizures..."

The term “pseudo-seizures” is extremely misleading. The seizures are quite real, and people who have then do not have conscious, voluntary control over them. They are “false” only in that they have no physical cause; rather, they are said to be psychological or physical reactions to stresses. Although their causes are different, “pseudo-seizures” definitely resemble epileptic seizures and often it’s difficult to tell the difference.

They may be generalized convulsions (similar to “grand-mal” epileptic seizures) that are characterized by falling and shaking. Others are similar to the “petit mal” or “complex partial” epileptic seizures that are limited to temporary loss of attention, “staring into space,” or “dozing off.” And although you may not have known that seizures can have psychological causes, many people have such seizures.

In fact, at the Cleveland Clinic, they see between 50 and 100 patients each year who suffer from pseudo-seizures — usually one or two patients each week. About 75% of these patients are women, and most are between the ages of 20 and 40, although pseudo-seizures occur in both younger and older patients as well.

Often, the misdiagnosis of epilepsy is common. Even experienced epileptologists can mistake non-epileptic seizures for epileptic seizures and vice versa. Epileptic seizures of frontal lobe origin are unfortunately often mistaken for non-epileptic seizures. And according to research, approximately 25% of patients with a previous diagnosis of epilepsy are misdiagnosed.  EEGs misinterpreted as providing evidence for epilepsy often contribute to this misdiagnosis. And reversing a misdiagnosis of epilepsy can be difficult, as it is with other chronic conditions. Unfortunately, after the diagnosis of seizures is made, it is easily perpetuated without being questioned.

To make things a little more confusing, there are two classifications among these non-epileptic seizures: a physiologic or a psychogenic seizure.  And even between the two types of “pseudo-seizures,” there is a difference…

Psychogenic Non-Epileptic Seizures – (PNES)

The first type of non-epileptic seizures, as defined by the Epilepsy Foundation, is psychogenic non-epileptic seizures. They’re seizures caused by psychological trauma or conflict that impacts the patient’s state of mind. 

The Epilepsy Foundation states that sexual or physical abuse is the leading cause of psychogenic seizures, where the abuse occurred during childhood or more recently: life changes, like death and divorce are another possible cause of a psychogenic seizures.  This form of seizure often resembles a complex partial or tonic-clonic (grand-mal) seizure, with generalized convulsions, stiffening, jerking, falling, shaking and crying. Less often, a psychogenic seizure resembles a complex partial seizure, with a temporary loss of attention.

Interestingly, about 1 in 6 of these patients either already has epileptic seizures or has had them. So different treatment is needed for each disorder. Psychogenic non-epileptic seizures are most often seen in adolescents and young adults, but they also can occur in children and the elderly. And they are three times more common in females!

Doctors have identified certain kinds of movements and patterns that seem to be more common in psychogenic 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 non-epileptic.

Video-EEG monitoring is the most effective way of diagnosing non-epileptic 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.

Although there is trauma involved, psychogenic non-epileptic 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.  And the prognosis is good, with 60 to 70 percent of patients alleviated of seizure symptoms.

Another possible way of coping is to reduce your stress, take time out, go for a walk, try deep breathing (but NOT hyperventilating!) music, meditation, muscle relaxation or even biofeedback.

And above all…be kind to yourself.

Physiologic Non-Epileptic Seizures (NES)

A physiologic seizure is a temporary loss of control that is often accompanied by convulsions, unconsciousness, or both. Most common are seizures, which are caused by a sudden abnormal electrical discharge in the brain.

Sometimes, and for lots of different reasons, one or another of these electrical discharges may grow and spread abnormally to other parts of the brain, which in turn generates their own abnormal discharges. This has a cascading effect, and within a few seconds, the entire cerebral cortex can be discharging at once.

The resulting seizures most often imitate complex partial or tonic-clonic (grand mal) seizures. Full loss of consciousness, stiffening and jerking of all four limbs, plus a period of confusion often accompany the event. 

Examples of medical causes of physiologic seizures include hypoglycemia, hypoatremia, cardiac arrhythmia, brain lesions, syncopal episodes, migraines and transient ischemic attacks.  The National Institutes of Neurological Disorders and Stroke adds that narcolepsy and Tourette syndrome are other possible causes of physiologic seizures. Differentiating physiologic seizures and epileptic seizures can be difficult, so medical assessment and careful monitoring is needed.

Keeping a daily seizure diary can be helpful, noting how you feel before a seizure (triggers?), during a seizure (symptoms?), and after a seizure, including the duration of the event.  This can help both you and your doctor better understand what is going on with your body.

And I would humb;ly suggest that you get a 2nd opinion. You might find a Newly Updated Comprehensive List of GOOD Neurologists…Epileptologists…Neurosurgeons…and Pediatric Doctors helpful. It's a compilation by website forum members who have had positive persoinal experiences with docs over the years.

And remember, stress is #1 on the hit parade of seizure triggers...no matter WHAT kind of seizure it is.

Best of luck to you.        Phylis Feiner Johnson   
www.epilepsytalk.com

Re: Epilepsy versus pseudoseizures

Thank you for all the good advice.  I really appreciate it.  I went to two different neurologists and they both told me that my seizures were due to stress.  They put me on Trileptal for awhile but ended up taking me off of it about 4 months ago.  I had my third seizure this past weekend with lack of sleep and lots of stress.  As I said, I am holding down the fort with my husband in law school.  Other than that, no childhood trauma, abuse, etc.  No experience like this before last year either.  All of my tests have come back normal as well, including a 2 day EEG.  I was asking about the pseudoseizures because I was under a great deal of stress each time these seizures occurred, especially with the first one being my husband having a heart attack.  Hopefully U of M will be able to help me.  Thanks again.