The relationship between Postural Orthostatic Tachycardia Syndrome (POTS) and non-epileptic seizures can be confusing. While POTS is a distinct condition, its symptoms may mimic or overlap with non-epileptic seizures. Understanding both conditions is important for accurate diagnosis and management.
Understanding POTS
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder affecting the autonomic nervous system, which controls involuntary bodily functions like heart rate, blood pressure, digestion, and body temperature. When a person with POTS stands up, their heart rate significantly increases within 10 minutes, without a substantial drop in blood pressure.
This rapid heart rate increase is the body’s attempt to compensate for blood pooling in the lower body. Symptoms include lightheadedness, dizziness, fainting or near-fainting, and extreme fatigue. Many also experience brain fog, affecting thinking, memory, and concentration. Other common symptoms are heart palpitations, chest pain, shortness of breath, headaches, and digestive issues like nausea or bloating.
Understanding Non-Epileptic Seizures
Non-epileptic seizures (NES) are episodes that resemble epileptic seizures but are not caused by abnormal electrical activity in the brain. Unlike epileptic seizures, which involve abnormal brain electrical activity, NES originate from different underlying causes. These causes can be either physiological, related to a physical condition, or psychological, often stemming from emotional distress or trauma.
NES can manifest in various ways, sometimes appearing similar to generalized epileptic seizures with symptoms like convulsions, stiffening, jerky movements, or temporary loss of consciousness. Other presentations include repetitive motions, staring spells, or sensory changes. Psychogenic non-epileptic seizures (PNES), a common subtype, are linked to psychological factors, where emotional experiences or trauma can physically manifest as seizure-like episodes. These events are involuntary.
The Connection Between POTS and Non-Epileptic Seizures
While POTS does not directly cause epileptic seizures, it is associated with non-epileptic events. One link is shared autonomic dysfunction, as both conditions can involve irregularities in the autonomic nervous system’s regulation.
Physiological stress from POTS symptoms can trigger NES-like episodes. For instance, severe lightheadedness, significant drops in cerebral blood flow, or fainting spells can lead to convulsive syncope. These movements result from the brain being deprived of blood flow, not abnormal electrical activity. Additionally, POTS patients often have co-occurring conditions like anxiety, panic disorders, or post-traumatic stress disorder, which are underlying factors for psychogenic non-epileptic seizures.
Distinguishing Seizure Types
Medical professionals use diagnostic tools and evaluation to differentiate between epileptic seizures, non-epileptic seizures, and POTS-related syncopal episodes. A detailed patient history, including eyewitness accounts, helps understand the prodrome, onset, evolution, and recovery period of the episodes.
Electroencephalogram (EEG) and video-EEG monitoring are primary diagnostic tools. Video-EEG records the brain’s electrical activity and captures corresponding behaviors. During a non-epileptic seizure, the EEG shows normal brain electrical activity, even with convulsive movements or loss of consciousness. In contrast, an epileptic seizure displays abnormal electrical discharges. Distinguishing convulsive syncope from epileptic seizures can be challenging, but convulsive movements during syncope are typically brief (10-15 seconds), with recovery of full awareness within minutes.
Seeking Diagnosis and Management Strategies
Individuals with symptoms suggestive of POTS or seizure-like episodes should seek professional medical evaluation. Consulting specialists like neurologists, cardiologists, and autonomic specialists is helpful for accurate diagnosis. A comprehensive evaluation helps rule out other conditions that mimic POTS symptoms or seizure activity.
POTS management includes lifestyle modifications like increased fluid and salt intake, compression garments, and reclined aerobic exercise. Medications may regulate heart rate and blood pressure. For non-epileptic seizures, treatment addresses underlying causes. If psychogenic non-epileptic seizures are diagnosed, psychological therapies like cognitive behavioral therapy are recommended. When physiological factors related to POTS contribute to NES-like events, managing POTS symptoms can reduce episode frequency or severity.