Anxiety is defined as a state of prolonged apprehension and nervousness, often accompanied by physical symptoms like a rapid heartbeat and sweating. Epilepsy, in contrast, is a neurological disorder characterized by recurrent, unprovoked seizures resulting from abnormal electrical discharges in the brain. While anxiety does not cause the underlying neurological condition of epilepsy, the relationship between psychological distress and seizure-like events is complex. Anxiety cannot create the structural brain changes that define true epilepsy, but it can trigger events that look very similar.
The Distinction Between Epilepsy and Non-Epileptic Seizures
The central difference lies in the brain’s electrical activity during the event. An epileptic seizure is a true electrical storm in the brain, detectable on an electroencephalogram (EEG), which records this abnormal neuronal firing. The resulting physical movements and loss of awareness are direct consequences of this chaotic electrical activity spreading through brain networks. This is a purely neurological event requiring specialized anti-seizure medication.
Anxiety or severe psychological trauma can lead to events known as Psychogenic Non-Epileptic Seizures (PNES), often called Non-Epileptic Seizures (NES). PNES are behavioral episodes that closely resemble epileptic seizures, including falling, rhythmic shaking, or unresponsiveness, but they are not caused by abnormal electrical brain activity. Instead, PNES are classified as a functional neurological disorder where the symptoms are rooted in psychological distress, acting as an involuntary physical manifestation of emotional conflict or trauma.
These episodes are not consciously faked; they are genuine and disabling events originating from the brain’s response to overwhelming stress. PNES is diagnosed by capturing an event on a video-EEG monitor, which shows the seizure-like behavior without the corresponding electrical abnormalities seen in epilepsy. This distinction determines the treatment approach, which involves psychotherapy and stress management rather than anti-seizure drugs, which are ineffective for PNES.
How Anxiety and Stress Interact with Existing Epilepsy
For individuals who have already been diagnosed with epilepsy, anxiety and psychological stress are consistently reported as major seizure triggers. The body’s physiological response to stress can significantly lower the seizure threshold, making the brain more susceptible to an electrical discharge. Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to an increased release of stress hormones, including cortisol.
These hormones can directly alter neuronal excitability in the brain, tipping the balance toward seizure initiation in an already vulnerable brain. Anxiety also frequently disrupts sleep patterns, often leading to chronic sleep deprivation. Because insufficient sleep is one of the most powerful triggers for seizures, anxiety indirectly increases seizure frequency by undermining restorative rest. Managing anxiety through techniques like cognitive behavioral therapy can therefore be an important component of controlling seizures in people with established epilepsy.
Common Causes of Epilepsy
Epilepsy is defined as a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. The actual cause of this enduring predisposition is typically neurological, not psychological. In many cases, the cause remains unknown, referred to as idiopathic epilepsy.
When a cause is identified, it is often related to structural abnormalities or injuries within the brain. These causes can include traumatic brain injuries, such as those resulting from a severe blow to the head, or conditions like stroke which cause damage by restricting blood flow. Other common causes are brain infections like meningitis or encephalitis, brain tumors, and certain genetic factors that influence brain development or function.
Recognizing the Difference Between a Panic Attack and a Seizure
Differentiating a panic attack from an epileptic seizure or a non-epileptic seizure is challenging, but several clinical characteristics can help distinguish them. A panic attack is a sudden surge of intense fear, peaking within about ten minutes, with symptoms such as palpitations, chest pain, and a fear of losing control. During a panic attack, a person generally remains aware of their surroundings and can recall the entire event afterward.
Most epileptic seizures, particularly convulsive ones, are much shorter, often lasting only one to three minutes. A key differentiator is the postictal state, which is the period immediately following an epileptic seizure. This state is marked by profound confusion, disorientation, fatigue, and sometimes deep sleep, which can last for minutes or hours. In contrast, following a panic attack, the person may feel exhausted and shaken but is not typically confused or disoriented.
The motor movements also differ, as an epileptic seizure often involves rhythmic, stereotyped movements like lip-smacking or repeated jerking motions. The shaking during a panic attack, while intense, is usually less organized and more generalized. Non-epileptic seizures (NES) may last much longer than epileptic seizures and often lack the postictal confusion characteristic of true epilepsy. Consulting a medical professional for proper video-EEG monitoring is the only definitive way to distinguish between these events.