Fibromyalgia (FM) is a chronic pain condition characterized by widespread body pain, fatigue, and cognitive difficulties. This complex condition involves central sensitization, which is an amplification of pain signals within the brain and spinal cord. Patients often report experiencing episodes that look and feel like seizures, leading to the question of whether FM causes true epilepsy. A clear distinction must be made between epileptic seizures, which result from abnormal electrical discharges in the brain, and seizure-like events that have a different neurological origin. This article examines the relationship between FM and seizure activity, distinguishing between true epilepsy and common non-epileptic events.
Direct Relationship: Clarifying the Link Between FM and Seizures
Fibromyalgia is not a primary electrical disorder of the brain, meaning it does not directly cause true epileptic seizures. The underlying mechanism of FM involves altered pain perception and sympathetic nervous system dysregulation, a different physiological process from the synchronous hyperexcitability of neurons that defines epilepsy. Epilepsy is characterized by electrophysiological abnormalities detectable on an electroencephalogram (EEG). FM’s central sensitization does not inherently produce these electrical storm patterns.
The prevalence of self-reported seizures is higher in individuals with FM compared to the general population, but this increased rate is largely due to non-epileptic events. While a small percentage of patients may have co-occurring epileptic seizures, the vast majority of seizure-like episodes are classified as psychogenic non-epileptic seizures (PNES). This pattern indicates that FM is not a cause of epilepsy but rather an associated condition sharing underlying neurological vulnerabilities.
Seizure Mimics: Non-Epileptic Events in FM Patients
The most frequent explanation for seizure-like episodes in FM patients is the occurrence of non-epileptic events, which are challenging to differentiate from true epilepsy. These events are often categorized as Psychogenic Non-Epileptic Seizures (PNES) or manifestations of Functional Neurological Disorder (FND). PNES events are involuntary physical manifestations of underlying emotional distress or pain, and are not caused by electrical disturbances in the brain.
In one study of FM patients presenting with paroxysmal spells, approximately 74% of the events were confirmed to be PNES. These episodes can dramatically mimic tonic-clonic seizures, involving shaking, loss of responsiveness, or staring spells. Unlike epileptic seizures, PNES often begin and end gradually, feature asynchronous limb movements, and may last for an unusually long duration. The high association between FM and PNES highlights a connection between chronic pain, psychological distress, and the body’s tendency to convert emotional signals into physical symptoms.
Shared Neurological Comorbidities
The presence of true epileptic seizures in a patient with fibromyalgia often points to a separate, co-occurring medical condition. FM frequently overlaps with other systemic disorders that inherently carry a risk for central nervous system involvement and epilepsy. Systemic Lupus Erythematosus (SLE), a chronic autoimmune disorder, is a common comorbidity for FM. SLE can lead to Neuropsychiatric Lupus (NPSLE), which causes inflammation and damage in the brain, significantly increasing the risk of true epileptic seizures by 2.86 to 4.70 times.
Certain connective tissue disorders, such as Ehlers-Danlos Syndrome (EDS), are also often found alongside FM. While hypermobile EDS (hEDS) does not appear to increase the overall risk of epilepsy, true epileptic seizures occur in patients with EDS who also have structural brain malformations. These malformations, like periventricular heterotopia, can create areas of abnormal electrical excitability. The presence of these underlying comorbidities, rather than FM itself, explains why some individuals with fibromyalgia experience genuine epilepsy.
Diagnostic Steps and Urgent Care Guidance
Any new, unexplained seizure-like activity requires prompt medical evaluation to distinguish between a true epileptic seizure and a non-epileptic event. The gold standard for this differential diagnosis is Video-EEG monitoring. This test simultaneously records the brain’s electrical activity (EEG) and the patient’s physical behavior (video) during an episode. A true epileptic seizure will show abnormal electrical spikes corresponding with physical symptoms, while a PNES event will have a normal EEG background.
Patients with FM who experience a first-time or significantly altered seizure-like episode should seek immediate medical attention. Emergency care is necessary to rule out acute, life-threatening causes such as stroke, infection, or metabolic imbalance. While PNES is not life-threatening, it can result in injury or lead to inappropriate treatment with anti-epileptic drugs. An accurate diagnosis through Video-EEG ensures the patient receives the correct treatment, which for PNES involves psychological approaches like Cognitive Behavioral Therapy (CBT).