by Dr. Lorin Bradbury
Question: What are pseudoseizures?
The preferred term is “nonepileptic seizures”, or “psychogenic nonepileptic seizures” (PNES), rather than pseudoseizures, though that term is still used in some professional literature. PNES are episodes of altered movement, sensations, or experiences resembling epilepsy, but not associated with the kind of electrical discharges in the brain usually detected during epileptic seizures.
The incidence of PNES is estimated to be between 5 and 25 percent of all persons treated for seizure disorders. And the leading epilepsy centers report that from 25 to near 40 percent of the patients referred for intractable epilepsy are found to be suffering from PNES.
PNES are psychogenic and are given the diagnosis of Conversion Disorder. If you are familiar with psychology, you will recall that Sigmund Freud made Conversion Disorder the focus of his study. At that time in history, many of the referrals that came to his neurology practice were suffering from a variety of unexplained physical symptoms including paralysis, contractures (muscles which contract and cannot be relaxed), and seizures. He viewed these patients presenting apparent neurological symptoms as a result of the conversion of intrapsychic distress in to physical symptoms. At one time, it was believed that this disorder had disappeared from the Western World, however, at present, it appears to be as prevalent as it ever was.
The cause of PNES is uncertain, but there is a higher rate of a history child abuse and posttraumatic stress among those diagnosed with PNES than those diagnosed with epilepsy.
To discriminate between PNES and epileptic seizures requires traveling to an epilepsy center, such as in Seattle, that has a video-EEG. Basically, a video-EEG video-records the patient’s manifestation of seizure activity while recording electrical activity in the brain. A normal EEG at the time of a physical manifestation of seizure activity is indicative of PNES.
Once a diagnosis has been made, the treatment of choice is psychotherapy to get at the cause of the underlying distress that produces the seizure-like behaviors. Approximately 15 percent of those diagnosed with PNES also have epilepsy, but that is usually controlled with medication. For the remaining 85 percent, they will no longer need to continue taking the antiseizure medication. The outcome for psychotherapy is relatively good with an estimated improvement in quality of life in 70 to 95 percent of the patients who undergo psychotherapy.
Lorin L. Bradbury, Ph.D. is a licensed psychologist in private practice in Bethel. For appointments, he can be reached at 543-3266. If you have questions that you would like Dr. Bradbury to answer in the Delta Discovery, please send them to The Delta Discovery, P.O. Box 1028, Bethel, AK 99559, or e-mail them to [email protected]