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What Are Psychogenic Nonepileptic Seizures (PNES)?

Learn about psychogenic nonepileptic seizures, or PNES, from Steve Wolf, MD and Patty McGoldrick, NP in this Howcast video.


The term, ‘non-epileptic seizures’, has a bunch of other names for it: non-epileptic seizures, pseudo seizures, schematic seizures. These are seizures that don’t have an EEG correlate, so the brain is not short-circuiting but clearly something is happening inside these patients. There’s usually a psychiatric component, there’s usually some deep seated psychological issue that’s going on. I always compare them to conversion reactions. So that your body is telling your brain or your mind that you’ve had enough, that you need to shut down for a while. And, whether it’s seizure, or you can’t move an arm or a leg, there’s some sort of reaction that goes on inside of you psychologically that says, ’I’ve had it, I need a rest, I’m overwhelmed by what ever is going on psychologically’. They’re treated by psychiatrists and they usually have a certain way that they look when we see them, or that people describe them. Now these non-epileptic events can present in many different ways. They can be just a zoning out, spacing out episode, a fainting to the ground, writhing and jerking on the ground. Sometime when we look at the non-epileptic events, we can tell by how they look whether they are a pseudo-seizure or a non-epileptic event or not. As you mentioned, there is a, frequently an underlying psychiatric component that comes up. Also the other important thing is, that we know is, many of these patients really do have regular epilepsy as well. Right. So, you can have, seizures, epileptic seizures and you can have pseudo seizures on top of it in the same person, they can co-exist. So, it’s really important from our point of view to know what we’re treating, so if the person comes in and they saying that they’re having lots and lots of seizures, we need to differentiate between the pseudo seizures or the non-epileptic and the real epileptic seizures. So, non-epileptic seizures, or psychogenic, non-epileptic events are seizures that can have many different causes. They need to be differentiated from regular epilepsy. The best way to do that is, to do video, eg, monitoring and capture the episodes and confirm them and then to work with a psychiatrist and psychologist to come up with a very aggressive treatment plan to deal with these type of seizures and make the patient feel comfortable that there is a plan in place to help treat them.

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