What are Pseudoseizures?
Seizure which is also known as convulsions is a condition in which an individual has involuntary and uncontrollable shaking of the body. This is caused due to a medical condition called epilepsy in which there is abnormal electrical activity in the brain cells or some physical damage to the brain cells.
Sometimes what happens is that an individual with no prior history of epilepsy for no rhyme or reason starts to have convulsions or rapid shaking of the body and sometimes even fainting episodes and when checked in the emergency department no abnormality is found in the functioning of the brain and there is no abnormal electrical activity in the brain cells. These episodes where there is no explainable cause for convulsions are termed as Pseudoseizures.
Pseudoseizures are also called as non-epileptic seizures. The cause of a Pseudoseizure is more often than not psychological like increased stress or some sort of emotional distress. Pseudoseizures will mimic the symptoms of a true seizure but will not show any abnormality on an electroencephalogram or EEG which is done to confirm the diagnosis of epilepsy.
What is the Difference between an Epileptic Seizure and a Pseudoseizure?
The main difference between a true or epileptic seizure and Pseudoseizure is that in true seizures there are clear electrical abnormalities seen on EEG in the brain whereas in Pseudoseizures no such abnormal activity is visible on the EEG. Another difference between a true seizure and a Pseudoseizure is that a true seizure episode lasts for a few seconds to a minute at maximum whereas attacks of Pseudoseizures last for much longer period of time.
What are the Causes of Pseudoseizures?
As stated, there is no medical cause for Pseudoseizures. They tend to occur due to some sort of psychological issue like increased stress at work, a disturbed environment at home, an emotional trauma of some sort. In other words, it may be said that Pseudoseizures are a psychological reaction of the brain to certain forms of stress or trauma. Pseudoseizures are mostly seen in people who have been victims of child abuse. Some people also use it as a means of escaping from work or get financial aid and hence Pseudoseizures can also be said to be a form of a behavioral disorder. Pseudoseizures are more common in adolescents and teenagers and tend to be seen more in females than in males.
What are the Symptoms of Pseudoseizures?
The symptoms of Pseudoseizures may mimic some of the symptoms of a true seizure like rapid shaking of the body, fainting episodes, change in behavior or confusion but the main difference with a true seizure being that these episodes lasts for a few seconds to minute in an epileptic seizure whereas these episodes will last for a longer period of time in a Pseudoseizure. Individuals having Pseudoseizures will tend to have convulsions and act as if they are losing consciousness. They may also complain of extreme anxiety and fear.
How are Pseudoseizures Diagnosed?
An electroencephalogram or an EEG is the best way to diagnose a Pseudoseizure and differentiate it from a true seizure. The physician will begin by first asking the patient as to how long has he been having the symptoms. The physician will also ask for duration of the symptoms. If Pseudoseizures are suspected, the physician will advise to take a recording of an episode of the convulsions. The physician will then monitor the electrical activity in the brain cells using an EEG. Pseudoseizures can be definitively confirmed if the EEG is taken during an episode so that the physician gets a first hand account of the episode and the corresponding electrical activity in the brain. If no abnormality is seen then Pseudoseizures are virtually confirmed.
How are Pseudoseizures Treated?
Before treatment for Pseudoseizures is started, the biggest challenge for the physician is to tell the patient that he or she is not suffering from epilepsy. This may sound weird but it can actually cause severe anxiety in the patient as to what is causing these symptoms and if he or she is having some other more serious condition. Hence, the physician needs to be very sensitive when telling the patient that what he or she is experiencing is not epilepsy but a form of a psychological disorder. The physician should clearly explain to the patient as to why epilepsy has been ruled out. The physician should also describe in detail the true condition of the patient without actually offending the patient and creating anxiety. The physician should reassure the patient that the condition is perfectly treatable with good psychological counseling. The physician should also tell the patient about different ways to get rid of stress.
In case of child abuse as being a contributing factor for pseudoseizure, then referral to a psychiatrist for psychotherapy has shown to be quite effective.
In case if the patient has been using antiepileptic medications then how to carefully wean the medication down to discontinuance. Medication wise, SSRIs have shown promise in treatment of Pseudoseizures and have been used successfully in some patients, although psychotherapy is the most preferred treatment for this disorder.
Cognitive behavioral therapy has also been used for treatment of Pseudoseizures. Antidepressants have also been used in some cases for treating Pseudoseizures.
What is the Prognosis of Pseudoseizures?
The prognosis of Pseudoseizures is not that good as a relatively few percentage of people actually undergo full treatment as most of them are lost to followups or do not attend therapy sessions and hence they continue to have attacks of Pseudoseizures. However, prognosis is good in people who are stronger willed, well educated, young in age, and have a will to get better and come out of the situation so that they suffer no more attacks and have less physical complaints due to Pseudoseizures.