Stress and anxiety are common psychological experiences that can manifest physically, sometimes resembling neurological events. A seizure is defined as a brief episode resulting from excessive and abnormal electrical activity in the brain, leading to involuntary movements or changes in consciousness. Stress is the body’s reaction to a challenge or demand, while anxiety is a feeling of worry or unease. The relationship between psychological distress and seizure-like activity is complex, involving events that occur in a brain predisposed to epilepsy and those that are purely psychological in origin.
Stress as a Seizure Trigger vs. Cause
For individuals with a diagnosed seizure disorder like epilepsy, stress and anxiety act primarily as a trigger. Stress lowers the brain’s threshold for a seizure, making an event more likely in a brain with underlying susceptibility. The stress itself does not cause the epilepsy condition to develop, but rather precipitates an event in a nervous system already prone to electrical misfiring. Conversely, emotional distress can be the underlying cause of seizure-like episodes in people who do not have epilepsy. These events look like true seizures but lack the abnormal electrical activity and are rooted in psychological factors.
How Stress Affects the Epileptic Brain
For a person with epilepsy, acute and chronic stress can affect the frequency and intensity of seizures. Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, the body’s central stress response system. This activation releases stress hormones, most notably cortisol and adrenaline, which alter brain chemistry and increase inflammation. High levels of cortisol are associated with a decreased seizure threshold, making the brain’s electrical activity unstable and more likely to produce a seizure.
The limbic system, which regulates emotions and includes the amygdala and hippocampus, is highly sensitive to stress activation and involved in seizure generation. Stress and anxiety frequently disrupt sleep patterns, and lack of adequate sleep is a well-known trigger for seizures. This creates a negative cycle where the anxiety about having a seizure leads to poor sleep, which in turn increases the risk of a seizure, fueling further anxiety.
Understanding Psychogenic Non-Epileptic Seizures (PNES)
Psychogenic Non-Epileptic Seizures (PNES) are events that physically resemble epileptic seizures but are not caused by abnormal electrical discharges in the brain. Instead, PNES are a manifestation of underlying psychological distress, emotional conflict, or trauma and are classified as a conversion disorder. They are common, accounting for up to 20 to 30% of cases referred to epilepsy centers for difficult-to-control seizures. PNES episodes often exhibit features that help distinguish them from true epileptic seizures.
PNES manifestations can include a gradual onset, a duration that is often longer than epileptic seizures, and the retention of some degree of consciousness or responsiveness during the event. Patients with PNES may also report more fear and weeping following the event, while those with epilepsy often experience amnesia or post-seizure aches. The gold standard for distinguishing PNES from epilepsy is video-electroencephalogram (video-EEG) monitoring. This test involves continuous recording of the patient’s brain waves and video observation until a typical event occurs. During a PNES event, the EEG will show normal brain activity, confirming the absence of the electrical storm characteristic of epilepsy.
Therapeutic Approaches to Managing Stress-Related Seizures
Effective management of seizures where stress is a factor requires both neurological and mental health care. For those with PNES, traditional anti-epileptic medications are ineffective. The primary treatment for PNES focuses on addressing the underlying psychological causes, most often through psychotherapy. Cognitive Behavioral Therapy (CBT) helps individuals recognize and develop healthier coping mechanisms for stressors and emotional distress. Mindfulness, deep breathing exercises, and relaxation techniques are also beneficial for regulating stress levels, which can reduce the likelihood of both PNES and stress-triggered epileptic seizures. When necessary, medications like antidepressants or anxiolytics may be prescribed to manage co-occurring anxiety or depression, but these treat the mental health condition rather than the seizure itself.