Meloncauli is a former nurse and anxiety management therapist. She hopes everyone can take something away from her articles.
No one should ever underestimate the effects and power of stress. We all deal with stress differently. Some unwind with a glass of wine and feel better for it—whilst others bite their nails and sleep poorly. Some people think they are handling stress fine, but stress is a funny old thing in that a stress-related disorder can appear suddenly, as if out of nowhere. Some are genuinely shocked when that first panicky feeling arises or indeed a full-blown panic attack. For others, they know deep down that this has been coming for a long time because they are fully aware they have been stressed to the hilt and are simply not dealing with it.
Imagine your brain is a circuit full of fuses. Imagine that each relies on the next to keep a circuit of balance and mental equilibrium. Now imagine that each worry for every day, week or year is zapping the energy from this circuit. This is ok if we give it a rest now and again because it has chance to recharge. If we handle that stressful situation adequately all will remain well but if too much stress and worry is piled into the circuit we reach burn out or overload and a fuse blows. When that fuse blows, the result can be a psychological disorder.
This is just my way of looking at stress overload and its consequences. A trauma long past, producing post traumatic stress disorder (PTSD) or other anxiety disorders such as panic disorder may make us particularly susceptible to nonepileptic seizures also. We can all take so much but there is a limit to what we can handle before we lay ourselves open to disorders. One of those stress related disorders is named a conversion disorder.
What is Conversion Disorder?
Simply put, a conversion disorder develops when psychological stress that has not been addressed or resolved, has built to such an extreme point, that it shows itself in a physical form. Because the symptoms of conversion disorder are brought about by emotional conflict they are said to be of psychogenic, psychological or psychosomatic origin. Unfortunately this can be interpreted as being ‘all in your head’ but whilst no medical origin can be found, the symptoms are far from being made up. In fact someone who discovers that they have a conversion disorder can feel just as confused as the doctors! You will feel you simply can not control the physical symptoms.
Symptoms of Conversion Disorder
- A conversion disorder can show itself in various physical ways such as:
- Paralysis usually in an arm or leg
- Blindness or severe visual disturbance
- Difficulty in swallowing (globus hystericus)
- Difficulty in speaking
- Difficulty in walking
- Difficulty with coordination and balance
In this article I want to look at the conversion disorder that causes someone to have nonepileptic seizures.
What are Nonepileptic Seizures?
Nonepileptic seizures are also commonly called pseudoseizures, psychogenic seizures, dissociative seizures, or nonepileptic attacks. They appear in varying degrees from trances that look like spells of staring to strong jerking movements that look like full tonic-clonic seizures (grand mal). If it wasn’t for the fact that you are conscious during a limb thrashing or jerking nonepileptic attack, people would automatically assume you were having a tonic-clonic seizure. That said, if eyes are closed during a nonepileptic seizure, people may assume you have become unconscious. Becoming semiconscious or blacking out can be a complication of a nonepileptic seizure, though it is the exception to the rule.
Just as with any epileptic seizure, a nonepileptic sufferer may fall to the ground and exhibit repetitive jerking of the limbs, usually all four limbs. Rigidity and severe shaking are common. It has been known for the person to urinate during an attack and bite their tongue, though this happens far less than in other forms of epilepsy.
Nonepileptic seizures can cause physical harm such as bruising just as with other epilepsy because the limb jerks can not be controlled by the sufferer. Epileptics tend to have auras before a seizure, and nonepileptic seizure sufferers also tend to get a warning of some nature slightly before a seizure begins. It might just be a strong uneasy feeling in the tummy, a strange headache, dizziness, or a feeling of losing awareness or concentration.
Some Differences Between Epileptic and Nonepileptic Seizures
|Eplieptic Seizure||Nonepileptic Seizure|
Abnormal electrical discharge
No abnormal electrical discharge
Of physical origin
Of psychological origin
Need for antiepileptic drugs
No need for antiepileptic drugs
Abnormal EEG reading
Normal EEG reading
Can occur in sleep
Do not occur in sleep
Tend to happen very suddenly
Can happen gradually
True synchronization of limb jerks
Sometimes changing limb jerks
Tendancy to urinate during seizure
Less likely to urinate
Biting the tongue happens frequently
Less likely to bite tongue
Loss of consciousness not unusual
Unconsciousness quite unusual
Diagnosis is tricky for doctors and psychiatrists. It isn’t unusual to be sent backwards and forwards between medical doctors and psychiatrists for some time before a diagnosis is made. Misdiagnosis is not uncommon when nonepileptic seizures begin. Your general doctor will initially order tests such as blood tests, and he will naturally presume if he sees one of your seizures that the cause is neurological. A referral to a neurologist is quite usual when these initial tests have yielded no positive results. This is the best route to a firm diagnosis as a neurologist will order specific testing before deciding on epilepsy or nonepilepsy. After examining your history of symptoms, tests that can confirm nonepileptic seizures are:
- Electroencephalogram (EEG) – to measure electrical activity in the brain. The downside to this test is that people without seizures can sometimes, if rarely, show abnormalities.
- Video Telemetry – having an EEG with video recorder monitoring over a longer period of time, usually a couple of days. The downside to this test is that of course you must have a nonepileptic seizure during the recording for accurate diagnosis.
How to Cope
From your first seizure to a firm diagnosis, you will probably go through a very confusing and worrying time. You will presume you have a medical illness because medical doctors are involved. When a psychiatrist insists there is a physical problem and a medical doctor insists it is a psychological problem, you are often left feeling as though your seizures don’t belong in any category! This is frightening because all you want is for your seizures to stop. You know you can’t stop them but it seems nobody else knows how to stop them either.
I will give you a word of advice to aid the process of diagnosis. Antiepileptic drugs will not stop nonepileptic seizures, and although you shouldn’t be on these drugs unless necessary, taking them for a brief time will tell you and the doctors that medical epileptic causes are unlikely if your seizures continue. I could also say that to try a small amount of a benzodiazepine (5-10mg), such as valium, directly on the tongue, at the onset of a seizure, should calm it down within 20-30 minutes. This will also point to a more likely scenario of nonepileptic seizures.
When you have had it confirmed that your seizures are of a psychological origin, you may feel many emotions. Shame and embarrassment are usual feelings on diagnosis but you must remember, you are not a malingerer and you are not making these symptoms happen consciously. You can not stop these seizures occurring and if you try hard to stop a seizure whilst it’s happening, such focus may even make the symptoms feel worse!
Nonepileptic seizures are frightening to the sufferer. You can feel distant whilst a seizure is taking place. You may not hear what people are saying or be able to observe your surroundings in clear focus. Your ability to speak during a seizure may be severely impaired. When it is over you may feel exhausted and feel physical pain from the severity of the limb jerks. Headache is common after a seizure, ironically much the same as with any seizure. You will often feel the onset of a seizure a minute or two before it takes on full strength and you can at least make sure you are in a safe place, preferably on the floor with nothing around you that may hurt you physically. Try to lie on your side if at all possible (as in the recovery position), with something protective under your head such as a pillow or cushion.
You should explain to those who live with you what you would like them to do whilst you are having a seizure. Just having someone with you is comforting but if they understand your seizures they can help you stay safe.
Nonepileptic seizures are difficult to treat, and a patient may have to wait some time before any psychological therapy can be arranged. A therapist may be able to help in coming to terms with the diagnosis, working out what caused you to start having the seizures, addressing the causes and learning how to cope with the actual seizures.
Self-Help for Nonepileptic Seizures
- Learn how to relax sufficiently
- Take up yoga or meditation
- Make a list of triggers and address the triggers
- Don’t be tempted to avoid situations and try and carry on as normal or you will develop other anxiety disorders
- Buy a medical alert wristband so that if the seizures happen amongst strangers, at least they will know you have such a condition
Remember, nonepileptic seizures can resolve completely, so don’t lose hope. Equally, remember how they arrived and do what you can to resolve the way you handle stress in your life.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Dina AH from United States on November 20, 2018:
This is quite helpful information. Thank you so much for sharing! I will definitely have to work on addressing triggers and also coming to terms with my own psychological pain through yoga and meditation. It is kind of taboo to talk about pseudoseizures because, as I have heard quite often, "they're not real." It's something we need to unpack as patients and families of patients. Definitely gave you a follow. Thank you for your awesome work.
noreen on May 21, 2018:
I had something strange happen a few weeks back,I went to get my grandson at school,I was early,i sat down,and i don't remember kids coming out the door I saw no parents,The next thing I know I went to school ofc to use bathroom,and my grandson was in the ofc.the school called his parentsand everything,I don't know what happened or if I even got up and wandered around,It scared me,the only thing I could figure was I had a thing calledtransient global amnesia Was it a seizure,if so .no one noticed
horsin on September 21, 2017:
I didn't even know there was such a thing until i read this article. I have had this all my life from a life-time of sexual and emotional abuse. The worse episodes were during EMDR therapy for PTSD, but once I learned to come to terms with my past thru EMDR, I have had no further non-epileptic seizures.
meloncauli (author) from UK on September 09, 2017:
Hi Freda. Yes they can be completely cured. They only exist basically because of very high levels of anxiety. Addressing anxiety levels with great persistence and dedication will bring about favourable results. Many people try but don't stick with it. It can be life changing to become aware of your limitations in taking on stress. I do hope your daughter can work towards ridding herself of these awful seizures.
Freda on September 07, 2017:
My question is can a person be completely cured from non-epileptic seizures cos presently my 25yr old daughter is suffering from PNES.
meloncauli (author) from UK on September 04, 2017:
I do hope he finds support and good advice. Non epileptic seizures as any dissociative state is often hard to treat, but with great determination a sufferer can learn how to minimise their anxiety levels to the extent that these seizures will abate.
Renee on September 03, 2017:
I believe my husband has this. He has had seizures but drs couldnt give us a diagnosis. I just found this article and am hoping there is a specialist in our area who can help. We have 2 young children and im hopeful we can move forward and try to live a normal life.
Kathy Challis on September 01, 2017:
I copied and gave full credit to you on my blog.
I had pseudoseizures back in the 1990's. Then, none from 2001 to 2017 March. When my psychiatrist died and another psychiatrist started taking me off my medications. Now I have them weekly and just finished the 72 hr video eeg. Since I didn't have a seizure on film; I think they will re-label me as pseudoseizures once again. Bummer!
Sugar78 on August 31, 2017:
I didn't even know that a person could have a non eplieptic seizure, until I had one. I honestly thought I was just tired, and I didn't know that I was that stressed out, until it happened.
meloncauli (author) from UK on August 26, 2017:
Chocoholic, my point is that non eplieptic seizures will show no telling activity on an EEG. Even temporal lobe epilepsy will show extreme activity usually in one side of the brain, but NES will show none.
meloncauli (author) from UK on August 25, 2017:
I personally haven't heard of anyone urinating with NES but of course it is very indicative of seizures generally. Does she ever have the seizures whilst she's alone or do they tend to happen when someone is in the vicinity?
Julie Oates on August 25, 2017:
Hi, my daughter has a diagnosis of non epileptic seizures and she has seizures at night and is incontinent of urine and requires a bed guard. She is 21 years old and this never happened before the seizures. She has had the full video telemetry and a diagnosis from Professor Reuber at Royal Hallamshire in Sheffield
Chocoholic on August 22, 2017:
I have had EEGs. I'm trying to really think back here. I don't know if I ever was diagnosed as having grand mal. I would imagine I would have had to of. There was a major time where it was really bad in high school - New Year's Day - where there were grand mals. EEGs definitely show a spike in activity, but I'm not sure if that's what you mean. Since then, it's been mostly smooth sailing. Up until the last 5 years that is, but life isn't all constantly turbulent. Thankfully there are pieces of calm.
meloncauli (author) from UK on August 21, 2017:
Were you officially diagnosed as having grand mal seizures with EEGs? High levels of anxiety can exacerbate real epilepsy.
Chocoholic on August 20, 2017:
Hi- question here. I've dealt with epilepsy most of my life although there were really no seizures until I missed medication after my daughter was born many years ago (to much to do, too little time) and basically unintentionally went cold turkey 10 days straight. Everything went along just fine- had my routine,job, etc. THEN it gradually got worse (my life that is) in the form of emotional abuse. Truly, truly awful. Won't go into details, but suffice it to say that's when the panic attacks, anxiety attacks, and more increased. I am 99.9% positive that the 3 grand meals I've had since then we're due to that considering the circumstances that had been building up since before then and the intensity just prior. Is there any information on this in relation to seizures? And yes, I'm still in this relationship and don't have the slightest idea of how to handle this.
meloncauli (author) from UK on July 04, 2017:
Do you get any warning at all at the onset? I can't imagine that shock therapy would help to be honest but thats just my opinion and not a substitute for medical advice. If the root of the problem is trauma induced high levels of stress, then focus on getting help for that. Repeated trauma can cause NES. Its as if the brain has become so overloaded but there is nowhere for all the mental effects to go...no release. Thats when dissociation can start and the overspill can come out in physical ways. Look at panic disorder. Thats usually a result of extreme stress. Address the root cause not the symptoms. Let us know how you get on.
Belinda on July 03, 2017:
I was treated for grand mal seizures for 30 years and only recently was admitted for 12 days on permanent eeg and camera monitoring. They diagnosed me with NES. I was taken off all my anti epileptic drugs. It has been 3 months now and the pre seizure jerking started about 5 days ago again. I am very nervous about everything starting again. Mine is trauma related. Anyone with advice and how they have been treated as I have been on psychotic meds for what seems like a lifetime. Does shock therapy help? I am truly desperate to get this thing solved. 30 years is a long time and I just want a solution for this.
TamLee from Massachusetts on November 22, 2016:
I wish this article had come about 10-years ago - but I am ever so THANKFUL that I have stumbled on it today. FINALLY ... the anti-seizure medication made the seizures worse and the initial merry-go-round of medications they had given me pains me until this day. The side effects of all the different medications were horrific and scarring.
Finally ... I don't feel alone or crazy about this and can finally point my doctors towards this so they can better understand what I evidently haven't been able to express.
Jessica on September 14, 2016:
while I do live my life with epilepsy I have been for a long time having these rigidity stiffening dropping things & such. really explains alot, I am working on better ways to work on the stress issues, meditation, yoga & removing toxic people from my life.
meloncauli (author) from UK on October 09, 2012:
Hi. That must be so difficult. I do hope you have a good relationship with your doctor. You really do need to share the burden of this problem
li on October 09, 2012:
Hi thank u.. I manage to hide mine though it is very difficult. Disabled toilets come in very handy. I am so scared I will lose my job if anyone finds out. I'm a nurse. I have loads of warning and can keep myself safe but it is exhausting. I feel so alone with this.
meloncauli (author) from UK on July 13, 2012:
Thanks gsidley. Your comment has prompted me to write on a new subject!
meloncauli (author) from UK on July 13, 2012:
Thanks for your comment Simone. Stress builds and people tend to forget that. What was stressful last year may still be affecting you this year if that stressor wasn't adequately addressed.
Dr. Gary L. Sidley from Lancashire, England on July 12, 2012:
A thoughtful description of a poorly understood disorder. As you say, sufferers can often be viewed as malingering and get a bad press within the services.
Simone Haruko Smith from San Francisco on July 11, 2012:
Yikes, I had no idea that stress could take such violent turns. Just the thought of it... stresses me out! Guess it's time to really focus on relaxation.
Thanks so much for this thorough explanation and all the advice. It's good to know where stress can go should it go un-checked- and what to do if one gets to that state.
meloncauli (author) from UK on July 11, 2012:
Thanks innerspin. Psychogenic amnesia is recognised as being related to chronic or severe stress.
Kim Kennedy from uk on July 11, 2012:
Thanks for a really interesting hub. Stress should not be taken lightly,though it's sometimes easier to look back and realise how it was building up rather than keep on top of things. I hadn't heard of non epileptic seizures, but can see how they might happen. My husband had an attack of amnesia after a stressful period, which was diagnosed as due to migraines. Stress certainly didn't help.
meloncauli (author) from UK on July 11, 2012:
William E Krill Jr from Hollidaysburg, PA on July 11, 2012:
Well done piece.
meloncauli (author) from UK on July 11, 2012:
Thanks for the comment brsmom68. Things always seem easier to handle when a proper diagnosis is made but the frustration in being in no mans land with a non epileptic seizure can feel terrible and add to the suffering. I do hope what happened to you doesn't happen again.
Diane Ziomek from Alberta, Canada on July 11, 2012:
This article couldn't have come at a more appropriate time; although a few months ago may have been better. It makes total sense as to what I suffered six months and eight months ago. All tests the doctor and neurologist ordered came back negative as far as epilepsy is concerned, so it makes me think (which I have though for awhile) it has been a build up of stress and not handling it properly. I can completely relate, although I did lose consciousness and suffered a dislocated shoulder as a result. Thank you for clarifying some some key points. Voted up, useful and interesting!