QUICK REFERENCE #30: What are some characteristics of psychogenic nonepileptic seizures?

Psychogenic nonepileptic seizures are involuntary episodes of movement, sensation, or behaviors (eg, vocalizations, crying, other expressions of emotion) that, although similar to epileptic seizures, are not caused by neurological activity. Instead, they appear to be “somatic manifestations of psychologic distress.”

Because psychogenic nonepileptic seizures can closely resemble epileptic seizures of any type (eg, generalized tonic-clonic seizures, absence seizures, and simple or complex partial seizures), they are often misdiagnosed and treated as such. To distinguish psychogenic nonepileptic seizures from epileptic seizures, the preferred diagnostic approach is the use of inpatient video-electroencephalography (vEEG). Psychogenic nonepileptic seizures are diagnosed if electroencephalographic abnormalities are absent during a seizure. Although some individuals with psychogenic nonepileptic seizures also have epileptic seizures, data indicate that most do not. “Typical features of these events include gradual onset, long duration, a waxing and waning course, and disorganized, asymmetric motor activity. The events lack the stereotypy of epileptic seizures because the pattern of symptoms and sequence of events vary between seizures.” However, not all seizures exhibiting these features are psychogenic nonepileptic seizures.

Patients with psychogenic nonepileptic seizures “have comorbid psychiatric illnesses, most commonly depression, posttraumatic stress disorder, other dissociative and somatoform disorders, and personality pathology, especially borderline personality type.” Patients with psychogenic nonepileptic seizures tend to have a poorer health-related quality of life than do patients with epilepsy (including patients with epilepsy that is difficult to manage).

Source: The Complete Practitioner: Mental Health Applications (October 2005), based on an article by Alsaadi TM & Marquez AV. Psychogenic nonepileptic seizures. American Family Physician, 72:849-856, 2005.

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