Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, profound fatigue, and sleep disturbances. Seizures are episodes of abnormal, uncontrolled electrical activity in the brain that cause changes in behavior, movements, or consciousness. Individuals experiencing both conditions often wonder if fibromyalgia causes these neurological episodes. This article examines the relationship between fibromyalgia and seizure activity.
The Direct Answer: Fibromyalgia Does Not Cause Epilepsy
Fibromyalgia is not classified as an epileptic disorder and does not directly cause true epileptic seizures. A true epileptic seizure arises from a sudden, synchronized, and abnormal electrical discharge in the brain’s neurons. Fibromyalgia is a pain processing disorder involving central nervous system sensitization, which uses a fundamentally different underlying mechanism.
The two conditions sometimes co-occur in the same patient, suggesting an associative link. Population studies show an increased prevalence of fibromyalgia among individuals diagnosed with epilepsy, and vice versa. This overlap indicates that shared biological vulnerabilities or common risk factors may be involved.
Understanding Seizure-Like Events in Fibromyalgia
A large part of the confusion stems from psychogenic non-epileptic seizures (PNES), which are common in the fibromyalgia population. PNES are episodes that closely resemble epileptic seizures, involving movements or altered awareness, but they are not caused by abnormal brain electrical activity. They are considered a functional neurological disorder where physical symptoms manifest in response to psychological distress or severe chronic pain.
Studies show that among fibromyalgia patients who experience paroxysmal neurological events, up to 74% are ultimately diagnosed with PNES. These events are physical manifestations of a nervous system overloaded by chronic pain signals, stress, and associated mood disorders. Unlike true epileptic seizures, PNES often feature non-stereotypical movements, can last for extended periods, and rarely cause self-injury.
Other fibromyalgia symptoms are sometimes mistaken for minor seizure activity. Severe muscle spasms and myoclonus, which are sudden, involuntary muscle jerks, can be misinterpreted as seizure-like movements. Episodes of intense “fibro fog,” characterized by cognitive impairment or disorientation, can also temporarily mimic an altered state of consciousness. These functional symptoms are rooted in central nervous system dysfunction but lack the electrical signature of epilepsy.
Shared Neurological Links and Comorbid Conditions
The co-occurrence of fibromyalgia and seizure disorders suggests shared underlying physiological pathways. Central sensitization is key to fibromyalgia, causing the nervous system to amplify pain signals and heighten sensitivity to stimuli. This state of constant neurological excitation may contribute to a lower threshold for other neurological disturbances.
Chronic pain modifies the activity of certain brain structures over time. This long-term neurological change, characteristic of fibromyalgia, could affect the brain’s susceptibility to paroxysmal events. Furthermore, both conditions share common comorbidities that complicate the clinical picture.
Conditions like chronic fatigue syndrome, migraines, anxiety disorders, and depression are frequently seen in patients with both fibromyalgia and seizure disorders. These co-occurring illnesses may share neurotransmitter imbalances or inflammatory pathways. The use of anti-seizure medications, such as gabapentin and pregabalin, to manage fibromyalgia pain further highlights this overlap in neurological targets.
Clinical Evaluation and Differential Diagnosis
When a patient with fibromyalgia reports seizure-like episodes, a thorough clinical evaluation is necessary. The distinction between true epileptic seizures and PNES is paramount because the treatments are entirely different. Misdiagnosing PNES as epilepsy can lead to ineffective and potentially harmful use of anti-epileptic drugs.
The definitive diagnostic tool for this differentiation is Video-Electroencephalography (VEEG) monitoring. This process involves continuous video recording of the patient’s physical events while simultaneously recording their brain’s electrical activity using an EEG. If a patient experiences an episode and the EEG tracing remains normal, the event is confirmed as non-epileptic, likely PNES.
A true epileptic seizure is accompanied by clear, abnormal electrical discharges visible on the EEG recording. Patient history is also invaluable, as a detailed description of the event’s onset, duration, and movements provides clues to the diagnosing neurologist. Other physiological causes, such as cardiac events or metabolic disorders, must also be ruled out.