Psychogenic nonepileptic seizures
| Psychogenic non-epileptic seizures | |
|---|---|
| Classification and external resources | |
| Specialty | psychiatry, psychology |
| ICD-10 | F44.5 |
| ICD-9-CM | 300.11, 780.39 |
| eMedicine | article/1184694 |
Psychogenic non-epileptic seizures (PNES) are events resembling an epileptic seizure, but without the characteristic electrical discharges associated with epilepsy. They are of psychological origin, and are one type of non-epileptic seizure mimics. PNES are also known less specifically as non-epileptic attack disorder (NEAD) and functional neurological symptom disorder.
People present with episodes that resemble seizures, and most have received a diagnosis of epilepsy and treatment for it. Most commonly the episodes in question are convulsive (whole body shaking) and resemble generalized tonic-clonic (“grand mal”) seizures, but they can be less dramatic and mimic milder types of seizures (partial seizures, absence seizures, myoclonic seizures).
Most people with PNES (75%) are women, with onset in the late teens to early twenties being typical.
A number of studies have also reported a high incidence of abnormal personality traits or personality disorders in people with PNES such as borderline personality. However, again, when an appropriate control group is used, the incidence of such characteristics is not always higher in PNES than in similar illnesses arising due to organic disease (e.g., epilepsy).
Other risk factors for PNES include having a diagnosis of epilepsy, having recently had a head injury or recently undergone neurosurgery.
The cause is by definition psychological, and can be categorized into several different psychiatric diagnoses. In the vast majority of people, the production of seizure-like symptoms is not under voluntary control, (i.e., the person is not faking). There are several diagnoses defined by the unconscious production of physical symptoms, including seizure-like events. A history of abuse or other psychological trauma is often present as a causative factor.
Occasionally, symptoms (seizures) can be feigned or faked voluntarily, and would fall under the categories of factitious disorder or malingering.
The differential diagnosis of PNES firstly involves ruling out epilepsy as the cause of the seizure episodes, along with other organic causes of non-epileptic seizures, including syncope, migraine, vertigo, anoxia, hypoglycemia, and stroke. However, between 5-20% of people with PNES also have epilepsy. Frontal lobe seizures can be mistaken for PNES, though these tend to have shorter duration, stereotyped patterns of movements and occurrence during sleep. Next, an exclusion of factitious disorder (a subconscious somatic symptom disorder, where seizures are caused by psychological reasons) and malingering (simulating seizures intentionally for conscious personal gain – such as monetary compensation or avoidance of criminal punishment) is conducted. Finally other psychiatric conditions that may superficially resemble seizures are eliminated, including panic disorder, schizophrenia, and depersonalisation disorder.
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