Breaking Down PNES

What are PNES?

Psychogenic non-epileptic seizures (PNES) are your body’s way of physically expressing emotional or psychological stress. PNES can mimic a seizure in the way the body moves, feels, or responds but there is a difference in what causes the seizure-like symptoms.

A seizure by definition is the result of excessive abnormal brain electrical activity. Brain electrical activity during a psychogenic event is normal – just as the name states, psychogenic non-epileptic seizures are not epileptic in origin. This does NOT mean that the disease “isn’t real” – PNES is a very real disease of psychological origin. An unfortunately common example of this type of disease is post-traumatic stress disorder (PTSD). Both PNES and PTSD are examples of disease that result from excessive stress triggering abnormal brain states – even though the brain anatomy and electrical functions are entirely normal.

PNES can be caused by traumatic events, abuse, or any other great loss or sudden change that produces huge amounts of stress. Psychogenic non-epileptic seizures are part of a group of mental health conditions called somatic symptom disorders – where the physical symptoms are an outcome of your body’s stress.

So, This is All in My Head?

No, PNES are serious medical events, and someone experiencing these events is not “crazy” or simply “faking it.” Psychogenic non-epileptic seizures can be disabling, but 60-70% of adults have had their seizure symptoms disappear with psychological-based treatment.

How do I know if I have PNES, Epilepsy, or Another Seizure Disorder?

There are two main differences: origin and treatment.

Origin – the difference between psychogenic non-epileptic seizures and epilepsy or other seizure disorders is whether or not there is abnormal brain activity. Seizures and epilepsy will show irregular brain wave patterns during a video EEG test while PNES will not.

VEEG testing is very important in the proper diagnosis of PNES as it is the only test that will help an epileptologist determine the source of the seizure-like symptoms. It is estimated that around 24% of people have been misdiagnosed with epilepsy when they really have PNES.¹

Treatment – Psychogenic non-epileptic seizures should be treated by a psychiatrist, psychologist, or clinical social worker. These trained mental health professionals will have a completely different treatment plan than what a neurologist would prescribe for epilepsy. Psychological interventions may include cognitive behavioral therapy (CBT), mindfulness based psychotherapy, interpersonal and psychodynamic psychotherapy, and prolonged exposure. These therapies can address both the symptoms and the underlying emotional conflicts that trigger the symptoms. Proper treatment is vital to reduce or become free of seizure-like symptoms.

How to Manage PNES

PNES can be a very tough diagnosis that can come with embarrassment, financial worry, and a higher risk for other illnesses such as depression or anxiety. However, these burdens can be managed with proper treatment for PNES.

Treatments include:

Cognitive behavior therapy: also known as talk therapy, where a therapist helps reshape negative thinking and behaviors
Journaling: multiple types of journaling can help such as seizure journals, emotion tracking journals, and freeform journaling
Medication: for other illnesses such as depression and anxiety
Psychoeducation: continuing to learn about mental health
PTSD or trauma therapy: there are a variety of therapies such as prolonged exposure therapy to eye movement desensitization or reprocessing
Stress-Reducing Practices: examples include meditation, exercise, saying “no” to overload, etc.

For a more in-depth discussion of coping strategies, always talk to your mental health professional to find a course of action that works best for you.

References

Benbadis SR, O’Neill E, Tatum WO, Heriaud L. Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center. Epilepsia. 2004;45(9):1150-3. doi:10.1111/j.0013-9580.2004.14504.