Neurologists have long been aware of fake seizures. People would fall and shake and even lose control of urine. Called pseudoseizures or psychogenic nonepileptic seizures, they can be involuntary due to psychological disturbances. Frightening to witness as family and observers can attest. Yet the patient can still bite and lacerate lips and tongue and be incontinent of urine and bowel despite the EEG brain waves remaining normal. Pseudoseizure can also be voluntary-malingered faked seizures of which the patient is very aware. These can serve some practical purpose in the person’s life e.g. avoiding stressful situations. These pseudoseizures occur in up to a third of patients evaluated in epilepsy clinics. One-third of patients who suffer from true epilepsy have additional pseudoseizures typically occurring during Their psychogenic nonepileptic seizures tend to occur when other people are present and during times of heightened emotional stress when secondary gain is available. Patients exhibiting feigned, or pseudoseizures, tend to have significant emotional problems. Schizophrenia, hysteria and hypochondriasis are common diagnoses.
Veterans
with psychogenic nonepileptic seizures tend to have higher rates of anxiety,
post-traumatic stress disorder and chronic pain, as compared with veterans with
true epileptic seizures. Civilians with psychogenic nonepileptic seizures
usually attribute their seizures to a past head injury, usually mild ones.
Selim
Benbadis, MD reviewed this topic in Neurology 2019;92: 311-312.1 Psychogenic
nonepileptic seizures (PNES) are so very common in epilepsy centers in the U.S.
that they account for 30-40 percent of referrals.2
Treatment
results of pseudoseizures are not encouraging. Adherence to psychotherapy and
cognitive behavioral therapy was poor. Minorities and victims of abuse tend not
to adhere to these therapies, but a better outcome is seen if they do adhere
over time.
Anticonvulsant
medications are usually disappointing. Convincing psychiatrists/psychologists
that their patients are suffering
pseudoseizures and not true epilepsy by neurologists can be difficult. Combined
psychological and organic neurological on-going cooperative care can lead to
success.
1)
Benbadis
SR. Psychogenic noonepileptic seizures, conversion, and somaic symptom
disorders. Neurology 2019;92: 311-312.
2)
Benbadis
SR. The Problem of psychogenic symptoms in the psychiatric community in
denial? Epilepsy Behav 2005;6:9-14.
Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.
