Psychogenic Non-Epileptic Seizures (PNES) are episodes that resemble the physical manifestations of an epileptic seizure but originate from a psychological cause, not from abnormal electrical activity in the brain. These events are also referred to as functional seizures or dissociative seizures and are a type of functional neurological disorder. The term “blackout” in this context refers to an episode of altered consciousness, unresponsiveness, or seizure-like behavior.
Psychological Origins of the Episode
Psychogenic non-epileptic seizures arise not from a neurological malfunction, but as an involuntary manifestation of psychological distress. The episodes are classified within the psychiatric framework, often meeting the criteria for a conversion disorder. This means that severe emotional or psychological conflicts, stress, or trauma are converted into physical symptoms.
The mechanism involves a disconnect between the brain and body function, where the nervous system physically reacts to a psychological burden. Common contributing factors often include unresolved trauma, chronic emotional distress, or maladaptive coping mechanisms. The symptoms are genuine and disabling, even though they do not result from an electrical storm in the brain.
Factors Influencing Episode Length
The duration of a psychogenic blackout is highly variable, but episodes are typically much longer than most epileptic seizures. While most generalized epileptic seizures last only a few seconds to a couple of minutes, PNES episodes frequently persist for several minutes, often exceeding two or three minutes. It is not uncommon for a psychogenic blackout to last ten minutes or even longer, a duration that strongly supports a PNES diagnosis.
The length of the episode is thought to be influenced by the triggering environment and the presence of observers, though the response is still involuntary. The underlying psychological state and the severity of the emotional trigger also play a significant role in determining how long the episode lasts. Because the episodes are not driven by a fixed electrical discharge pattern, their duration often waxes and wanes, lacking the predictable, time-limited nature of most epileptic events.
Observable Features During a Psychogenic Blackout
The movements observed during a psychogenic blackout often lack the synchronized, rhythmic pattern characteristic of a tonic-clonic epileptic seizure. Movements may appear asynchronous, or they may involve side-to-side head shaking and pelvic thrusting. A fluctuating course, where the intensity of the seizure-like activity increases and decreases over time, is a reliable feature seen more commonly in PNES.
A particularly distinguishing sign is the patient’s eyes often being closed tightly, resisting attempts to open them, which is referred to as ictal eye closure. In contrast, the eyes are typically open in a person experiencing a generalized epileptic seizure. The patient may also exhibit ictal crying or weeping during the episode. These observable features help clinicians identify PNES, especially when confirmed by video-EEG monitoring that shows no abnormal electrical brain activity during the event.
Immediate State Following the Event
Once the psychogenic blackout concludes, the person’s return to full baseline awareness is often rapid, distinguishing it from the recovery phase of an epileptic seizure. Unlike a generalized epileptic seizure, which is typically followed by a period of deep post-ictal confusion, profound sleepiness, or labored breathing, PNES usually lacks this significant post-event alteration in consciousness.
Though physically recovered almost immediately, the individual may feel exhausted, distressed, or emotionally overwhelmed after the event. They may also retain some memory of the events that occurred during the episode. The convulsive movements in PNES rarely lead to the kind of significant physical injuries, such as tongue biting or broken bones, that can sometimes be associated with a hard fall during an epileptic seizure.