Non-epileptic Seizures: Causes, Types and Management

What Are Non-Epileptic Seizures?

A non-epileptic seizure (NES) is an episode that resembles the symptoms and signs of epileptic seizures. However, it is caused by factors unrelated to electrical activity in the brain. Instead, most of these seizures involve a physical reaction to traumatic or stressful events and therefore belong to the category of psychogenic non-epileptic seizures (PNES). Certain physical health conditions can also trigger non-epileptic seizures.

Psychogenic non-epileptic spells or seizures involve converting mental stress into physical symptoms. The diagnosis of PNES is sometimes interchangeable with conversion disorder or functional neurological disorder, but this is not applicable in every case.

Many people experiencing seizures similar to epilepsy may get misdiagnosed. On the other hand, it is possible to have NES and epilepsy at the same time. Epilepsy-related seizures and non-epileptic episodes cooccur in around 10-15% of the cases.

What Do Non-Epileptic Seizures Look Like?

Non-epileptic seizures are usually difficult to distinguish from epilepsy-related seizures. Some psychogenic non-epileptic spells involve sudden and brief loss of consciousness, confusion, and unresponsiveness. In order to recognise PNES symptoms, the medical team should focus on signs like side-to-side head shaking, pelvic thrusting, and eye closure.

This type of seizure may involve involuntary motor movements and yelling phrases. The individual is usually unable to communicate during the episode, and their mouth tends to be clenched.

Types of Non-Epileptic Seizures

There are several potential causes and triggers for non-epileptic seizures. To understand these episodes better, healthcare professionals distinguish three main types of non-epileptic seizures: dissociative seizures, seizures with physical causes, and seizures with psychological causes. Listed below are the characteristics and symptoms associated with them.

Dissociative Seizures

Dissociative seizures are characterised by uncontrollable behaviours and movements. In dissociative seizures, the individual is not fully aware or in control. These episodes can be linked to post-traumatic stress disorder and involve a physical reaction to stressful events, such as physical abuse or trauma. According to mental health professionals, dissociative seizures occur when the brain needs to shut down and protect itself from immense distress.

The symptoms of a dissociative seizure vary from one person to another. While some of these episodes resemble an epileptic seizure. During a dissociative seizure, the person may collapse, make involuntary movements, bite their tongue, lose control over their bladder, or simply go blank and stare in an unresponsive state.

Non-Epileptic Seizures with an Organic Cause

Unlike dissociative and psychogenic seizures, some non-epileptic seizures have underlying physical causes. Some of the most common risk factors for seizures with organic causes include diabetes, cardiac diseases, or low blood pressure that leads to sudden changes in the brain’s oxygen supply.

Non-Epileptic Seizures with Psychological Causes

Non-epileptic seizures with psychological causes, also called psychogenic non-epileptic seizures, are episodes of uncontrollable movement and behaviour that occur as a result of psychological distress. Due to the similarity of the symptoms, these episodes are often mistaken for epilepsy-related seizures. Experiencing generalised convulsions similar to signs of epilepsy may lead to misdiagnosis.

PNES symptoms almost inevitably cooccur with mental health challenges, such as depression, post-traumatic stress disorder, and various personality disorders.

Non-Epileptic Seizures Symptoms

Recognising the common signs and symptoms of a non-epileptic seizure is crucial for healthcare teams to provide rapid and reliable assistance. Usually, the following symptoms are caused by non-epileptic seizures:

Non-Epileptic Seizures in Children

Children with non-epileptic seizures may experience similar symptoms to those in adults, but this is not always the case. For example, studies have shown that non-epileptic seizures in early childhood are characterised by an unresponsive state, whereas older children are more likely to experience symptoms linked to movement.

Non-epileptic seizures in children is an area that requires more extensive research. According to existing studies, these are the distinguishable symptoms of NES in school-aged children:

What Causes Non-Epileptic Seizures?

When it comes to psychogenic non-epileptic seizures, medical experts often link these episodes to conversion disorder or functional neurological disorder. This mental health condition involves the manifestation of emotional distress as somatic symptoms. Apart from serving as defence mechanisms in response to underlying mental distress, non-epileptic seizures can also occur due to various physical illnesses.

The following challenges can lead to non-epileptic seizures:

What Triggers Non-Epileptic Seizures?

While some non-epileptic seizures seemingly occur out of the blue, others may be related to specific triggers. Medical experts distinguish two types of seizure triggers – internal (inside the person’s body) and external (outside the body). Triggers inside the body include physical ailments or distressing thoughts, memories, and emotions. On the other hand, triggers outside the body include various types of sensory input, such as loud noises, intense smells, and flashing lights.

Some non-epileptic seizures may occur without the presence of any detectable trigger while the person is resting or relaxing. With the help of dedicated physicians and support workers, people with NES can keep track of the changes in thoughts, vulnerable states, and environmental triggers that lead to these episodes. This way, they can take control of their symptoms and live fulfilling lives.

Non-epileptic Seizures While Sleeping

According to some studies, people with psychogenic and other non-epileptic seizures often experience sleep disturbances. Educating individuals with NES about the significance of sleep and healthy sleep habits should be one of the main goals of treatment programs. Medical experts may also perform sleep assessments on patients with non-epileptic seizures in order to help them improve their overall health and quality of life.

Similar to nocturnal seizures in individuals with epilepsy, people with non-epileptic seizures while sleeping may require waking night care services. A waking night carer is available during the night for any kind of assistance. They can provide people with a rapid response, preventing possible complications or seizure-related injuries.

Non Epileptic Seizures and Driving

Most medical experts agree that individuals with active non-epileptic seizures should avoid driving if they meet certain criteria, including the following:

Individuals with non-epileptic seizures, in general, are advised against pursuing a career as commercial drivers. However, people with NES can drive non-commercial (private) vehicles under some alleviating circumstances.

Seizure Care and Support with Leaf Complex Care

At Leaf Complex Care, we provide home care services for individuals with psychogenic non-epileptic episodes and other forms of NES. We deliver humanised, person-centred support for people with PNES and aim to maximise their independence.

Our support workers take a revolutionary approach to helping individuals manage mental stress and control their seizures. The care team is available at any time of the day to meet your needs and prevent possible seizure-related injuries. Our care plans focus on your human rights and prioritise your privacy, dignity, and personal boundaries.

If you need home care services for yourself or a loved one experiencing non-epileptic seizures, Leaf Complex Care is the right place for you. We deliver CQC-regulated support for children and adults in Bristol, Slough, Somerset and the Midlands.