Volume 2 Issue 4 April, 2012
Consultation Liaison Psychiatry
Pseudo seizures are attacks that look like epileptic seizures, but are not caused by abnormal electrical discharges. They are better termed as Psychogenic (non‐epileptic) seizures ( PNES) or non epileptic attack disorders and older terms pseudo seizures or hysterical seizures are discouraged. PNES are a physical manifestation of psychological disturbance and is a somatoform disorder with unconscious production of physical symptoms. PNES falls in to category of conversion disorder with seizures in according to (DSM‐IV). PNES are not rare; seen in 20‐30% of patients referred for refractory seizures. PNES typically begin in young adulthood (10‐18 years) and more frequently seen in women (≈ 70%).
PNES are suspected when the seizures have unusual features. A Specific triggering factors such as traumatic events with, physical or sexual abuse, incest, divorce, death of a loved one, or other great loss or sudden change, can be identified that are unusual for epilepsy. There will be preserved awareness, eye flutter and episode affected by the bystanders. Epileptic seizures are abrupt in onset, eye opening/ widening, tongue biting, ictal cry, post ictal confusion or sleep. Physical and neurological examination in PNES is usually normal. Resistance to antiepileptic drugs in patient diagnosed as epilepsy is usually the first clue for the diagnosis. In malingering and factitious disorders, patient is purposely deceiving the physician or faking symptoms. Somatoform disorders including PNES are real conditions that arise in response to real stresses; patients are not faking them.
The most reliable test for diagnosis is continuous EEG‐video monitoring. A small proportion (10%) of patients also have epilepsy. It is important to rule out absence seizures, complex partial seizures, epilepsy with mental retardation, frontal lobe epilepsy.
Most important step in initiating treatment is communicating the diagnosis! Since most of the patients are previously diagnosed as organic disease (eg, epilepsy), there can be disbelief, denial or anger as a reaction. Treatment may involve psychotherapy, stress‐reduction techniques (such as relaxation and biofeedback training), and cognitive‐behavioral therapy. AEDs should be gradually (not abruptly) stopped. No need to limit activities. No increase risk of motor vehicle accidents.
With proper treatment, the seizures eventually disappear in 60‐ 70% of adults; the percentages are even higher for children and adolescents. Young patients generally differ from adult patients only in that the stresses are typically less severe. An important factor for better outcome is the early diagnosis.
AssistantProfessorofPediatrics,AIMS
