Why Some Seizures Are Not Caused By Epilepsy

Factors such as psychological stress can trigger events

Contributors: Elaine Wyllie, MD and Becky Tilahun, PhD

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If you or a loved one have epilepsy and continue to experience seizures despite treatment with appropriate medications, it may be for one of three reasons:

  • Because the medication dose is not sufficiently high to control the seizures.
  • The chosen drug is not the optimal choice from among the many available.
  • The epilepsy is inherently drug-resistant and difficult to control.

However, in some cases, it’s none of the above. If the seizures are due to a psychological factor rather than epilepsy, then epilepsy treatments will not be effective because the diagnosis is incorrect.

Non-epileptic seizures occur in approximately 2 to 3 per 100,000 people overall. These seizures usually start between ages 10 and 35, and are most common among people in their 20s and 30s. They are four times more common in adolescent and adult women than men, but among children, they are equally frequent among boys and girls. People may have a mix of epileptic and non-epileptic seizures, or they may have non-epileptic seizures alone.

Telling the difference

It can often be difficult for friends and family to tell the difference between epileptic and non-epileptic seizures, since the outward signs are similar.

Symptoms of non-epileptic seizures may range from unresponsiveness with limp and motionless body tone to jerky movements of the body and limbs. Non-epileptic seizures may last minutes or even hours, and they may occur sporadically or as often as several times a day.

Similar to epileptic seizures, non-epileptic episodes may be very disruptive to the individuals who experience them, and they often result in school or work absence, repeated visits to the emergency department and even hospital stays.

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Doctors diagnose non-epileptic seizures with an EEG, or brain wave test. During epileptic seizures, the brain’s electrical activity is transiently disturbed, and this disturbance can be clearly seen on the EEG.

In contrast, during non-epileptic seizures, the EEG brain wave recording remains normal. Confirming the diagnosis of non-epileptic seizures may require a brief hospital stay, but it is the critical first step toward resolving the condition.

Treatment for non-epileptic seizures

Once non-epileptic seizures are confirmed, the treatment shifts from prescribing seizure medication to exploring and addressing possible emotional or psychological factors. Many people experiencing non-epileptic seizures have suffered emotional, physical or sexual abuse, and for children, school difficulties, bullying or family discord may play a role.

Non-epileptic seizures often co-exist with other conditions, such as post-traumatic stress disorder, depression, anxiety and chronic pain or headache, and these also must be addressed. Recognizing stresses, treating associated conditions and developing effective coping mechanisms are key goals for therapy.

Being diagnosed with non-epileptic seizures does not mean patients are weak because they’ve been unable to cope effectively with psychological stressors, or that it’s all in their head.

A person experiencing non-epileptic seizures is not at fault, and their symptoms are not intentionally produced. Erroneous thoughts and feelings such as these are not uncommon among people experiencing non-epileptic seizures.

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An important goal of therapy is to dispel these myths, so that the person can begin an effective healing process.

Sometimes non-epileptic seizures resolve almost immediately after a confident diagnosis is made, and in other cases, more extensive therapy is required.

The good news is that most people with non-epileptic seizures can eventually enjoy full recovery and live normal lives. Reaching out for help from a specialized epilepsy center is the first step.

This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic.

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