Dissociative seizures, also known as Psychogenic Non-Epileptic Seizures (PNES), are a neurological condition resembling epileptic seizures but stemming from psychological distress rather than abnormal brain electrical activity. These events are involuntary and represent a genuine physical manifestation of underlying psychological factors. This article aims to describe the typical observable characteristics of dissociative seizures, helping individuals recognize their presentation. Understanding these visual cues can assist in appropriate recognition.
Key Differences from Epileptic Seizures
Distinguishing dissociative seizures from epileptic seizures involves specific characteristics. During a dissociative seizure, a person’s eyes frequently remain closed, flutter, or resist opening when an observer attempts to gently open them. In contrast, during many epileptic seizures, the eyes typically stay open and may appear staring. Responsiveness also differs, as individuals experiencing a dissociative seizure might show partial awareness or respond to a familiar voice or touch, whereas those in a grand mal epileptic seizure are generally unresponsive.
Duration and movement patterns also provide distinctions. Dissociative seizures often last longer and vary in length, sometimes extending for minutes or hours. Epileptic seizures, particularly tonic-clonic types, usually follow a more predictable, shorter course. Movements during dissociative seizures are frequently asynchronous, with different limbs moving independently, or they can appear theatrical, such as arching or flailing. This contrasts with the rhythmic, synchronized tonic-clonic movements often seen in epileptic seizures.
The state after the event also varies. Individuals experiencing a dissociative seizure typically recover more quickly, regaining full awareness and communication rapidly. They do not exhibit the confusion, deep sleep, or prolonged disorientation common after an epileptic seizure.
Observable Physical Signs
Dissociative seizures manifest through a range of observable physical signs. Body movements can be prominent, often involving thrashing, flailing of limbs, or rocking motions. Some individuals may exhibit pelvic thrusting or side-to-side head shaking. These movements can appear disorganized and lack the rhythmic, patterned nature sometimes seen in other seizure types.
Vocalizations are common, including moaning, crying, or screaming. Some individuals might verbalize words or phrases, which is less typical in epileptic seizures where vocalizations are usually non-verbal. Changes in posture and muscle tone are frequently observed, ranging from rigidity or stiffening to sudden limpness. Muscle tone might also fluctuate rapidly between these states during the seizure.
The appearance of the face provides additional visual cues. Facial expressions can include grimacing, staring blankly, or the eyes remaining closed with fluttering eyelids. Breathing patterns during a dissociative seizure may also be irregular, with some individuals experiencing hyperventilation or shallow breathing.
Diverse Ways Dissociative Seizures Present
Dissociative seizures display considerable diversity in their presentation, not following a single, uniform pattern. Their appearance can vary significantly between individuals and even within the same person across multiple events. Some presentations can be quite dramatic, closely resembling generalized tonic-clonic epileptic seizures with extensive body movements and unresponsiveness.
Conversely, other dissociative seizures may manifest in more subtle ways, less immediately recognizable as a seizure. These can include brief staring spells where the individual appears to zone out, or periods of trembling without significant thrashing. Some presentations involve short periods of unresponsiveness without dramatic motor activity. The exact appearance can also sometimes be influenced by the presence of observers or the surrounding environment, though this influence is not intentional.
Responding to a Dissociative Seizure
When witnessing a dissociative seizure, focus on ensuring the individual’s safety. Gently move any nearby objects that could cause injury during movements. Speaking calmly and reassuringly to the person can sometimes help, as they may retain some level of awareness. It is important to avoid physically restraining the individual, as this can cause distress or injury.
Observing the seizure’s specific characteristics, such as duration, movement types, and any signs of responsiveness, is helpful. This information can be valuable for medical professionals assessing the event. Unless there is an injury or significant doubt about the event’s nature, calling emergency services may not be necessary. Instead, seeking a non-emergency medical evaluation is generally the appropriate next step.