Psychogenic non-epileptic seizures (PNES) are episodes that resemble epileptic seizures but are not caused by abnormal electrical activity in the brain. They are instead rooted in psychological distress. This article explores the nature of PNES, its treatment approaches, factors influencing recovery, and the long-term outlook for individuals living with this condition.
Understanding Psychogenic Non-Epileptic Seizures
Psychogenic non-epileptic seizures are events that can outwardly appear similar to epileptic seizures, involving symptoms such as loss of consciousness, shaking, or unresponsiveness. Individuals may experience convulsive movements, including stiffening, jerking, or thrashing of limbs, and some may fall. Less frequently, PNES can mimic absence seizures or cause a brief lapse in awareness. Unlike epilepsy, PNES arises from psychological distress or trauma, not abnormal brain activity.
Symptoms of PNES vary, affecting movement, sensation, and emotional states. Common signs include changes in movement patterns, convulsive-type episodes where awareness is retained, unresponsiveness with eyes closed, or full-body shaking that lasts longer than typical epileptic seizures. While epileptic seizures often lead to confusion or deep sleep afterward, PNES episodes typically do not, and they tend to result in fewer physical injuries.
Diagnosis of PNES relies on video-EEG (electroencephalogram) monitoring. During this test, patients are monitored with a video camera and an EEG until an episode occurs. The EEG measures brain activity; in PNES, it shows normal electrical activity during an episode. This diagnostic clarity is important for differentiating PNES from epilepsy and guiding appropriate treatment.
Treatment Approaches
Treatment primarily involves psychotherapy. Cognitive Behavioral Therapy (CBT) is the most evidence-based approach for managing PNES. CBT helps individuals understand the connection between their emotional states and seizure occurrences, developing coping mechanisms to reduce seizure frequency. CBT involves education about seizure types, identifying triggers, and improving emotion management skills. Studies indicate that CBT can significantly reduce seizure frequency and improve psychiatric symptoms and psychosocial functioning.
Other therapeutic approaches may be beneficial. Psychodynamic psychotherapy helps individuals address emotional struggles and improve relationships, potentially lowering daily emotional distress and reducing PNES frequency. Eye Movement Desensitization and Reprocessing (EMDR) has shown promise in treating PNES when trauma is an underlying factor. EMDR aims to reduce the distress associated with traumatic memories, which can manifest as physical symptoms like PNES.
Medication is not effective for directly treating PNES. Anti-seizure medications will not help a person with PNES and can cause adverse side effects. However, medication may be prescribed to manage co-occurring mental health conditions, such as depression, anxiety, or PTSD. Treating these co-existing conditions is an important part of a comprehensive PNES management plan.
Factors Influencing Recovery
Remission from PNES is possible, but recovery depends on several factors. Early diagnosis and intervention are significant predictors of a positive outcome. The longer a patient is treated for presumed epilepsy, the poorer the prognosis tends to be. Prompt and accurate diagnosis allows for the initiation of appropriate psychological treatment, which is essential for improvement.
Adherence to psychotherapy, especially CBT, plays a substantial role in recovery. Engaging actively in therapy, working through emotional issues, and practicing coping strategies learned in sessions are associated with better outcomes.
The absence of severe or complex trauma or the ability to process such trauma effectively influences the path to recovery. A younger age at PNES onset and fewer severe psychiatric comorbidities are associated with a better prognosis. Conversely, long-standing PNES, severe co-occurring psychiatric conditions, or personality disorders can make recovery more challenging. Social support and patient motivation also contribute to successful outcomes.
Long-Term Outlook
Many individuals with PNES can achieve remission and become seizure-free. Research indicates that between 20% and 50% of people may stop having PNES once a diagnosis is reached, even without specific treatment. For those undergoing psychological treatments, improvement can be observed within three months of therapy. Some studies show that 47% of patients receiving psychological interventions become seizure-free, and 82% experience at least a 50% reduction in seizure frequency.
Despite the potential for seizure freedom, recurrence is common and linked to new stressors or therapy discontinuation. Ongoing psychological support or applying coping strategies learned in therapy are important to maintain wellness and prevent relapse. While complete cessation may be ambitious for some, a significant reduction in seizure frequency is a common and valuable outcome. For many, achieving remission from PNES leads to a notable improvement in their overall quality of life and psychosocial functioning.