One study followed people who had experienced a seizure over an average of eight years. Among them, 33 percent had a second seizure within four years, and the remaining people were seizure-free for the rest of the study. Of those who had a second seizure, there was about a 73 percent chance of a third seizure within those four years. (2) Many physical and psychological issues can lead to seizures. Additionally, the causes of some seizures are never identified. People are not usually diagnosed with epilepsy after just one seizure, and they are not usually prescribed antiseizure drugs. Acute symptomatic seizures can also be caused by some metabolic irregularities:
Hypoglycemia (low blood sugar), usually in people with diabetesHyperglycemia (high blood sugar), usually in people with diabetesHyponatremia (low blood sodium)Hypocalcemia (low blood calcium)Hypomagnesemia (low blood magnesium)Uremia (having urea in the blood), sometimes seen in people with chronic kidney failureHyperthyroidism (overactive thyroid gland)Substance or medication withdrawal, especially from alcohol (usually occurring within 7 to 48 hours of the last drink) or benzodiazepines, including drugs such as diazepam (Valium), lorazepam (Ativan), or alprazolam (Xanax)Drug intoxication, poisoning, or overdoses of illicit drugs — like cocaine, amphetamines, or PCP — or some prescription medicationsPreeclampsia (high blood pressure and signs of organ damage during or after pregnancy)Impaired liver functionStress, missing meals, or sleep deprivation
It is estimated that 5 to 20 percent of people diagnosed with epilepsy may actually have nonepileptic seizures. Among people diagnosed with intractable seizures (seizures that aren’t responding well to treatment) who seek inpatient epilepsy monitoring, 25 to 40 percent are later diagnosed with PNES. PNES is believed to be a type of disorder called a “conversion” disorder. Conversion disorders are physical symptoms that don’t have an underlying physical cause. Instead, the symptoms are caused by a psychological conflict.
Diagnosing Nonepileptic Seizures
The diagnostic test called a video EEG (electroencephalogram) is the common way to determine whether seizures are psychogenic (arising from the psyche). A video camera captures the features of the person’s seizures; meanwhile, an EEG captures readings of the person’s electrical brain waves. The two can later be compared side by side to see if there is a correlation between the seizure activity and brain wave activity. EEGs are not foolproof, however. Approximately 15 to 33 percent of focal seizures — which are epileptic seizures — are too deep in the brain or cover too small an area of the brain to be perceived by EEG electrodes. Additionally, movement from tonic-clonic seizures can obscure EEG results. What’s more, some people may have both epileptic seizures and PNES.
Treating Nonepileptic Seizures
The recommended treatment for PNES is psychotherapy, particularly cognitive behavioral therapy. Other recommended therapies include interpersonal therapy and group therapy. Because nonepileptic seizures are believed to be similar to post-traumatic stress disorder (PTSD), some people have found that the medications and treatment approaches for PTSD are helpful in treating their seizures. The treatment called eye movement desensitization and reprocessing has been found to be helpful in PTSD and in nonepileptic seizures, but not in epilepsy. Clinicians are often careful how they deliver a diagnosis of PNES because it can sound like telling someone they are crazy. Not only are people with PNES not crazy but their seizures are real and disabling. Because PNES seizures have a different cause and treatment from epileptic seizures, getting a PNES diagnosis can help guide a person toward more helpful and less toxic treatment than epilepsy treatment.
Narcolepsy (sudden attacks of sleep)Tourette’s syndrome (repetitive involuntary movements or tics)Cardiac arrhythmia (irregular heartbeat)Syncope (fainting)MigrainesTransient ischemic attacks (mini-strokes)Panic attacks
Further diagnostic tests can reveal that these conditions are not epilepsy.
