In today’s world we all are running after money, love, peace of mind (not necessarily in that order though). In order to grab on to these we indulge in self-harm. We push ourselves more and more which causes stress. A lot of things can lead to stress. Causes of work-related stress can be many: Heavy work load, long hours of work, facing harassment at work, terrible working conditions or not being fond of whatever we are doing. Problems in our personal life can also cause tension, for example, loss of a dear one, going through a traumatic situation, going through a divorce, deteriorating financial condition, moving to a new home, etc.
Measures can be taken to reduce stress if it isn’t too much; however, the level of stress can go out of our hands. There are physical intonations of how stress can affect our body. People suffer from headaches, stomach upsets, acne, low energy, chest pain and many more. Stress can be reduced by eating properly, by reducing intake of caffeine, alcohol and nicotine, by meditation or by exercising, maintaining proper diet and getting enough sleep.
What are Seizures?
Seizures are caused due to certain misfiring of nerve cells in the brain or due to the changes taking place in the chemical composition in the nerve cells. Seizures cannot be defined as a disease, but an indication of more harmful malfunctioning of the body. Seizures can be broadly classified into epileptic seizures and non-epileptic seizures.
Can Stress Lead To Seizures?
Epileptic seizures essentially start in the brain due to disturbances in the neurological balance of the brain. The patient cannot recall what just happened, the body becomes stiff, and suffers from jerking movements. These are the ideal symptoms of epileptic seizures.
Other kinds of seizures (non-epileptic seizures or NES) may affect a particular person due to low blood sugar level and improper working of the heart. Therefore, we can now find the connection between stress and seizures. We know that stress causes hypoglycemia and malfunctioning of the heart and non-epileptic seizures are a result of these occurrences. These kinds of seizures are called physiologic seizures.
What are Psychogenic Non-Epileptic Seizures?
Psychogenic Non-Epileptic Seizures are caused due to stressors (agents that cause stress). Around 20% to 30% of the patients who are being treated in the epilepsy centers are actually patients of Psychogenic Non-Epileptic Seizures. Not many people talk about this topic because this was considered to be an intractable condition for a long time. Psychogenic Non-Epileptic Seizures may be detected by unusual movements and triggers. It may have two ways of showing itself. They may look like epileptic seizures, but they really aren’t. Seizures that involve falling and shaking are termed as tonic-clonic seizures, these are generalized convulsions. Another form of assertion is, staring aimlessly as a result of temporary loss of attention. This is called absence seizures or complex partial seizures.
Stress & Psychogenic Non-Epileptic Seizures
Excessive mental pressure/stress due to divorce, incest, sexual abuse etc. may result in the physical manifestation of the psychological distress. Somatoform disorder and conversion disorder are categories under which Psychogenic Non-Epileptic Seizures falls. Somatoform disorder or conversion disorders are physical manifestations whose roots cannot be traced by a test or an examination. The psychological dispute inside a human brain transforms itself in such a way so as to come out as a neurological disorder. The seizures caused in such a case are completely involuntary and start abruptly. This is more common among women, especially during their growth years, their adolescence. Symptoms of conversion disorder are numbness, paralysis, double visions, blindness, urine retention, excessive aggression, experiencing difficulty in swallowing, impaired body balance, deafness, aphonia and many others. The episodes of the seizures span over a short period of time, but may become chronic in nature if not treated within time. These can get aggravated even further if the patient suffers from anxiety attacks, has any other neurological problem, dissociative personality disorders or having a family member suffering from any neurological disease.
Types of Movements in Psychogenic Non-Epileptic Seizures
Psychogenic Non-Epileptic Seizures can also be distinguished on the basis of the tremors that are felt by the patients. Rhythmic tremor accounts for 46.7% of the PNES patients. They are termed as Rhythmic Motor Psychogenic Non-Epileptic Seizures. The seizures occur in a rhythm and in synchronized fashion. The upper limbs are affected more than the lower limbs and are unresponsive during seizures and also characterized by hyperventilation.
Hypermotor movements account for 3.3% of Psychogenic Non-Epileptic Seizures patients. Kicking and punching type of movements are displayed by such patients.
Complex motor movements account for about 10% of Psychogenic Non-Epileptic Seizures and include pelvic thrusting and back-arching and these movements are subtle.
Dialeptic PNES which results in prolonged unresponsiveness and coma-like state (11.2%).
Non-epileptic auras (23.6%), video EEG can detect sensations, but has no physical manifestations, like in a state of “zoning out.”
Mixed PNES, which is a combination of any aforementioned types.
If Psychogenic Non-Epileptic Seizures is not treated and is left for later, it can cause permanent personality and behavioral changes or a permanent substantial disability.
Treatment of Psychogenic Non-Epileptic Seizures and Taboo Related To PNES
The physicians, to begin with are not given proper training or proper devices to diagnose Psychogenic Non-Epileptic Seizures. Most of the patients are prescribed anti-epileptic drugs when the patients are not suffering from it at all. This is because the barely trained doctors miss the subtle differences between epileptic and non- epileptic seizures. The video EEG (electroencephalogram) device is not available with most of the doctors which is an essential machine for the epileptologist.
It is sad that every form of neurological problem is still considered as “madness”, “insanity” or “craziness” by most of the people. Even people suffering from the disease refuse to be a victim and are in a state of denial, skepticism and suspicion. The recovery of the patient to a great extent depends upon the acceptance of the disease by the patient and also acceptance of the patient by the people around him or her. The will power of the patient to fight back to regain the previous self is very important. The people around the patient should be supportive and not suspend it as a case of mere “madness.” A person suffering from Psychogenic Non-Epileptic Seizures should be under the surveillance of a doctor as soon as the symptoms begin to show.
Dr. Benbadis, who is the director of Comprehensive Epilepsy Program urges the masses to talk more freely about, in many cases unavoidable, condition and not considered it as a taboo. According to him video EEG monitoring should be the way in which Psychogenic Non-Epileptic Seizures should be measured and only EEG is not appropriate enough which can be used for diagnosing epilepsy alone. In the video monitoring process the patient is kept under surveillance, spanning over a period of a few days to a few weeks. This process is continued until the patient suffers from the next seizure. After the report received from the EEG and the video, the patient is referred to a psychiatrist for further check up. Once the patient is under the observation of a psychiatrist, the patient should be treated with speech therapy, stress reduction therapy, hypnosis, psychotherapy and any other method of curing which will reduce the trauma he or she had gone through.
Hence, we can come to the conclusion that around the world a large portion of the population are deprived of proper therapy solely attributable to ignorance and retraction. Catering to this, education regarding to enlightenment of the masses about mental health awareness is a must.
- American Psychological Association. (n.d.). Stress Effects on the Body. https://www.apa.org/topics/stress/body
- Mayo Clinic. (2022). Epileptic Seizures. https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093
- Psychiatric Times. (2013). Psychogenic Non-Epileptic Seizures. https://www.psychiatrictimes.com/view/psychogenic-non-epileptic-seizures
- Reuber, M., & House, A. (2003). Pseudoseizures: Unresolved Issues and Unanswered Questions. Epilepsy & Behavior, 4(3), 293–304. https://doi.org/10.1016/s1525-5050(03)00104-8
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Publishing.
- Benbadis, S. R. (2014). Psychogenic Nonepileptic Seizures: Recognition, Clinical Presentation, and Differential Diagnosis. Epilepsy Currents, 14(1), 13–18. https://doi.org/10.5698/1535-7597-14.1.13
- Benbadis, S. R., & LaFrance Jr, W. C. (2015). Psychogenic Nonepileptic Seizures: A Practical Guide. Springer International Publishing.
- American Epilepsy Society. (n.d.). Psychological Issues. https://www.aesnet.org/patients/about-epilepsy/psychological-issues
- Gaitatzis, A., Sander, J. W., & The National Psychogenic Nonepileptic Seizures Study. (2003). The Long-Term Outcome of Psychogenic Nonepileptic Seizures: A Longitudinal Study of 80 Cases. Annals of Neurology, 53(3), 305–311. https://doi.org/10.1002/ana.10443
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