Nonepileptic seizures are events that can look like epileptic seizures but they are not caused by abnormal electrical firing in the brain. Treatment advice for dissociative attacks nonepileptic attacks seizures this document is reproduced from. There is an average delay of seven years before dissociative seizures are correctly diagnosed. Listing a study does not mean it has been evaluated by the u. Dissociative seizures are commonly recognized as both a challenging and a poorly understood condition. Cognitivebehavioral therapy for psychogenic nonepileptic. Dissociative seizures, nonepileptic seizures nes epilepsy. This document is designed to make this information easier to print off. All the links in the website and all the downloadable information in one place. How can a person tell the difference between a seizure and a dissociative episode. Their manifestations may include alterations of consciousness such as trance or stupor, amnesia, andor hypermotor seizures with more or less rhythmic movements of the head and trunk, muscle stiffness, and tremorlike movements. Most commonly the episodes in question are convulsive whole body shaking and resemble generalized tonicclonic grand mal seizures, but they can be less dramatic and mimic milder types of seizures partial seizures, absence seizures, myoclonic. Dissociation in patients with dissociative seizures.
Epilepsy incidence rates by age 10 100 0 10 20 30 40 50 60 70 80 all epilepsy types age years incidence per 100,000 data from rochester, mn 197584 hauser wa et al. Functional neurological disorders fnd are common and associated with significant morbidity and healthcare costs. Unlike epilepsy, dissociative attacks are not due to abnormal electrical discharges in the brain or another nervous system disease. Pdf cognitive behavioural therapy versus standardised. The seizure happens because their emotional reaction causes a physical effect. Dissociative seizuresfrom clinical picture to the treatment. Ictal symptoms of anxiety, avoidance behaviour, and. Information for patients taking control of your non.
Treating psychogenic nonepileptic seizures counseling today. Many people with nonepileptic seizures or anxiety attacks find that their breathing becomes difficult or quick and shallow before a seizure. Mellers department of neuropsychiatry, maudsley hospital, denmark hill, london up to one in five people diagnosed with epilepsy will turn out to have dissociative seizures ds psychologically mediated episodes of altered awareness andor behaviour that may. The person splits off or dissociates from their feelings about the experience because it is too difficult to cope with. A total of 444 9% patients with epilepsy and 222 9% patients with dissociative seizures were found to have mild sleep. However, the treatment of such patients is always challenging and frustrating due to poor response to the routinely used interventions in most situations. These are referred to briefly in this section, but are fully described and elaborated in the basic and specific cbt domains of the cbt. Aug 11, 2019 using hypnotherapy to treat psychogenic nonepileptic seizures mark barrus last updated august 11, 2019 posted in hypnotherapy even though psychogenic epileptic seizures are not prompted by unusual brain electrical discharges, these occurrences can cause emotional and mental distress.
Comparing different treatments in reducing dissociative. The myoclonic seizure itself is a rare phenomenon and when functional movement disorder presents like myoclonus then its extremely difficult to pinpoint the exact cause. It can make you feel strange and lightheaded and more likely to have a seizure. E1745 march 2011 with 4,359 reads how we measure reads. Dissociative seizures alone do not constitute a morbidity in the sense of a diagnostic group, and, strictly speaking, the notion of comorbidity in this context is simply wrong. Dissociative convulsions, a prominent form of dissociative conversion disorder formerly known as hysteria, are a common and elusive differential diagnosis from epilepsy. Dissociative seizures are paroxysmal episodes of altered behaviour resembling epileptic seizures, however, there is no underlying organic cause, including epilepsy. General psychiatric assessment instruments do not cover dsmiv dissociative disorders. A randomised controlled trial neurology this booklet was provided in the study to participants in neurologyspecialist epilepsy clinics to explain what dissociative seizures are. If you would like to print a poster advertising the website for your clinic room. From what i have read, a dissociative state sounds very much like a petit mal seizure. Introduction to seizures and epilepsy va epilepsy basics. This paper describes the diagnostic evaluation of seizure disorders, including clinical assessment and the role of. There are many different names for dissociative seizures.
Pnes are also known less specifically as nonepileptic attack disorder nead and functional neurological symptom. Such drugs are only useful if people have both nonepileptic and epileptic seizures. Dissociative seizures are one of the three common disorders which, between them, account for over 90% of clinical presentations with transient loss of consciousness. Some 10% of patients with dissociative seizures have epileptic seizures, whose onset almost always precedes that of the dissociative seizures. Between 3040% of patients admitted to our hospital for attacks that do not improve with medicines turn out to have non epileptic seizures, and are taken off medications. Patients with predominantly hyperkinetic dissociative seizures had a shorter disorder duration prior to diagnosis in this study than patients with hypokinetic seizures. The majority of such patients suffer from psychologically mediated episodes. Nationally, it is estimated that 23 people in 10,000 suffer from these attacks.
Cognitive behaviour therapy cbt for dissociative nonepileptic seizures this listing of competences assumes that practitioners are familiar with, and able to deploy, a range of generic cbt techniques. Dissociative seizures look very similar to other types of seizures but are not actually seizures by definition. The recommendations in this guideline represent the view of nice, arrived at after careful consideration of the evidence available. You may feel as if you are detached from your surroundings or as if the room is moving around, or just get a feeling of unreality. Sometimes people who have nonepileptic seizures are told that they suffer from nonepileptic attack. Here, we present a case with dissociative convulsions in order to. These expressions are quite unfortunate as they convey a stigma and instigate the idea that people with histrionic personality disorder suffer from dissociative seizures. Abdominal breathing is a way of controlling your breathing. Outcome was better in patients with greater educational attainments, younger onset and diagnosis, attacks with less dramatic features, fewer additional somatoform complaints, and lower. Psychogenic nonepileptic seizures pnes are events resembling an epileptic seizure, but without the characteristic electrical discharges associated with epilepsy. Characteristics of 698 patients with dissociative seizures.
In the lesson, we will learn more about dissociative seizures and what causes them. The approach to patients with nonepileptic seizures. Dissociative seizures look very similar to epileptic seizures but are very different. Dissociative seizures happen for psychological reasons rather than physical ones. These events cannot be controlled by the people who have them. The potential complications of such diagnostic delays include the adverse effects of antiepileptic medications, iatrogenic complications e.
History and careful observation and examination are critical to diagnosis, as investigations will often be normal or noncontributory. Pnes presenting symptoms involve a wide array of nervous system functions, including changes in behavior, motor activity, sensation, cognitive, and autonomic functions. Instead they are psychologically determined and, as patients with pnes may be misdiagnosed as having. The seizures can look like any kind of epileptic seizure. Aug 2010 and is designed to be used together with that website. Often dissociative seizures are how the brain reacts to thoughts or feelings related to present and past experiences. Studies using the sdq20, which mostly comprises items pertaining to pseudoneurological phenomena e. The cognitive behavioural therapy versus standardised medical care for adults with dissociative nonepileptic seizures codes trial is an evaluation of a specifically tailored psychological.
Conversely, psychogenic ness are thought to be caused by the mind and have been known by the terms. Other names you may hear are nonepileptic seizures nes, nonepileptic events, psychogenic seizures, functional seizures, dissociative seizures, pseudoseizures or pseudoepileptic seizures. Their close superficial resemblance to epileptic seizures makes them hard to diagnose. Dissociated will be a feature length documentary about dissociative seizures, also known as nonepileptic attack disorder nead or psychogenic nonepileptic seizures pnes. An additional aim was to assess possible relationships between dissociation, traumatic experiences, posttraumatic symptoms and seizure manifestations in this group. A complete neurodiagnostic evaluation along with an awareness of this relationship is needed to provide appropriate care for this patient population.
Selective literature search in pubmed and psycinfo. Psychogenic nonepileptic seizures pnes are sudden, involuntary seizurelike attacks that, unlike epileptic seizures, are not related to electrographic ictal discharges. A guide for patients and families, selim benbadis and leanne heriaud suggest that the competent treatment of pnes will result in the elimination of seizures in 60 to 70 percent of adults, and the results for children and adolescents may be even more impressive. Cognitive behaviour therapy cbt for dissociative non. Dissociative seizures genetic and rare diseases information. Dissociative psychopathology, nonepileptic seizures, and. Up to one fifth of patients who present to specialist clinics with seizures do not have epilepsy. Diagnosis and management of dissociative seizures john d. Psychogenic nonepileptic seizures pose a management problem psychogenic nonepileptic seizures pnes, while superficially resembling epileptic seizures, are not accompanied by the abnormal electrical discharges associated with epilepsy and cannot be explained by other medical conditions. Apr 12, 20 dissociative seizures resemble epileptic seizures but have no electrophysiological correlate. Dissociative non epileptic attacks are disabling and frightening attacks that look very similar to epilepsy.
Nonepileptic seizures happen because of problems with handling thoughts, memories, emotions or sensations in the brain. Abnormal sleep in patients with epileptic or dissociative. There are indeed some distinct similarities in the signs for both some types of seizures and a dissociative disorder. Pdf characteristics of 698 patients with dissociative.
Many largescale epidemiological studies led to biased results due to this deficit in their methodology. Persons with dissociative seizures constitute a mixed group with a wide variety of predisposing, precipitating, and maintaining factors. Dissociative seizures, or psychogenic nonepileptic seizures, are involuntary experiential and behavioural responses to internal or external triggers that superficially resemble epileptic seizures but which are not associated with the abnormal electrical activity associated with epileptic seizures. Dissociative seizures can happen as a cutoff mechanism to stop bad memories from being relived.
Patients with fnd often present acutely, particularly with dissociative seizures resembling epilepsy or persistent weakness resembling a stroke. Three 7% patients with epilepsy were found to have mild or moderate obstructive sleep apneahypopnea syndrome osahs and three 14% patients with dissociative seizures had mild or moderate osahs. Other names you may hear are nonepileptic seizures, nonepileptic attacks or events, nonepileptic attack disorder nead, psychogenic seizures, functional seizures, pseudoseizures or pseudoepileptic seizures. To examine anxiety related seizure symptoms and avoidance behaviour in adults with dissociative psychogenic nonepileptic seizures ds in comparison with a group suffering from partial epilepsy. Aug 26, 2016 in their article psychogenic nonepileptic seizures. They are of psychological origin, and are one type of nonepileptic seizure mimics. The potential complications of such diagnostic delays include the adverse effects of antiepileptic medications, iatrogenic. In the usa, 2 to 33 of every 100 000 persons suffer. Though research and publication activity is high, advances in knowledge and insight seem only moderate in recent years. There are many different names for nonepileptic attacks. Dissociative seizures, often having similar manifestations to that of seizures in the absence of paroxysmal neuronal discharge, pose a significant burden on the patients, their family and the healthcare system. Many people with nonepileptic seizures have been given antiepileptic drugs.
Dissociative or psychogenic nonepileptic seizures pnes are involuntary episodes of movement, sensation, or behaviors vocalizations, crying, and other expressions of emotion that do not result from abnormal brain discharges. A dissociative seizure is usually provoked by emotional stimulation or a stressful situation of which neither the patient nor the people around him are usually aware. Comparing different treatments in reducing dissociative seizure occurrence codes the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. In this lesson we will learn about dissociative seizures and what symptoms are associated with them. A case of dissociative seizures presented like myoclonic. Assessment of patients with psychogenic nonepileptic seizures. Dissociative convulsions nonepileptic seizures recent estimates suggest that between 9% and 50% of patients referred to specialist epilepsy centres have paroxysmal events that, despite resembling true epileptic episodes, are actually nonepileptic. With grateful thanks to northumberland, tyne and wear nhs trust for permission. They can be called nonepileptic attacks or nonepileptic seizures. Antiepileptic drugs have no effect on nonepileptic seizures and they often cause side effects. Cognitive behavioural therapy vs standardised medical care. Jul 22, 2009 from what i have read, a dissociative state sounds very much like a petit mal seizure. This paper describes the diagnostic evaluation of seizure disorders, including clinical assessment and the role of special investigations. Research and treatment must focus on the underlying psychiatric disorder.