This review discusses the common differential diagnoses of epileptic seizures, including syncope and psychogenic nonepileptic seizures (PNES). PNES are defined as paroxysmal changes in behavior, motor, sensory, autonomic, cognitive, and/or emotion that are not epileptic seizures. They are often misdiagnosed and mistreated as epilepsy, with most patients having a psychological factor such as mood disorder, anxiety, PTSD, and maladaptive coping styles.
PNES involve attacks that resemble epilepsy-related seizures in symptoms and signs, but abnormal electrical activity in the brain does not. Video EEG is the gold standard for diagnosing PNES, but a negative video EEG does not exclude the diagnosis of epileptic seizures. Clinical features and a single pathognomonic sign or symptom cannot reliably differentiate PNES from epileptic seizures.
PNES are attacks that may look like epileptic seizures but are not epileptic and instead caused by psychological factors. Psychogenic spells are most often caused by mental stress or a physical condition, including depression, anxiety, stress, physical or sexual abuse, or suffering. Diagnosis involves one or more symptoms of altered voluntary motor or sensory function. Clinical findings provide evidence of incompatibility between the symptom and the epileptic seizure.
The objective of this review is to determine if psychogenic nonepileptic spells can be differentiated from epileptic seizures based on psychological issues and symptoms. Panic attack symptoms may assist in distinguishing PNES from seizures secondary to epilepsy.
📹 What are Psychogenic Nonepileptic Seizures (PNES)
In USA, please call the clinic Psychogenic Nonepileptic Seizures (PNES) are very common and yet very often missed. In this video …
How often is PNES misdiagnosed?
PNES is a condition where individuals may initially receive a misdiagnosis of epilepsy, but it can also result in both PNES and epilepsy-related seizures. The main symptom is seizure-like attacks, which can resemble epilepsy-related seizures but are triggered by emotional stress. Some individuals may appear like generalized convulsions, while others may have twitching or jerking in their limbs. PNES episodes can mimic absence seizures or drop attacks. Healthcare providers cannot determine if someone is having a PNES attack or an epilepsy-related seizure based on observation alone. Seizure symptoms that highly suggest PNES include:
What does a fake seizure look like?
It is not uncommon for families and staff to observe individuals with Down syndrome experiencing seizures, which may manifest as involuntary movements, a lack of awareness, shaking, or stiffness. Such seizures are observed to occur on an infrequent basis, specifically when the individual is attending a novel event or in the presence of a new attendant. On rare occasions, individuals with Down syndrome are transported by ambulance to the emergency room for further evaluation, including computed tomography scans and laboratory tests, which typically yield normal results.
Can PNES be faked?
Psychogenic Nonepileptic Seizures (PNES) are a real condition arising from real stressors, not consciously produced by the patient. Diagnosing PNES can be challenging, as the events resemble epileptic seizures. The Epilepsy Foundation states that 20-30 of individuals without Down syndrome with drug-resistant seizures may actually have PNES. Video EEG monitoring can help clarify the diagnosis by attaching wires to the person’s head and recording the results.
The test can indicate if an event is consistent with a non-epileptic seizure if there are no abnormalities on the EEG. The Resource Library has a visual for individuals with Down syndrome called Getting an EEG that explains the test.
How to tell a pseudo seizure?
Psychogenic nonepileptic seizures (PNES), also known as pseudoseizures, are a type of seizure with a psychological cause and do not involve changes to electrical impulses in the brain. Symptoms may include sudden unresponsiveness, changes in consciousness, shaking movements, and closing the eyes, mouth, or staring spells. PNES is preferred over pseudoseizures, as the term “pseudo” may imply a person pretending to have a seizure. This article provides an in-depth understanding of PNES, its causes, symptoms, treatment options, and outlook.
What does PNES feel like?
PNES episodes often affect cognitive functioning, with about half of patients experiencing changes in consciousness and awareness. Over half report having some memory of items or able to recall parts of what happened during the episode. Many patients feel distant from their environment, similar to an “out of body” experience, and are described as going blank or absent. Speech and sound production can vary, with patients sometimes completely mute but hearing a range of sounds. Injuries and loss of bladder control can occur, such as tongue biting and urinary incontinence. Fallings to the floor, cuts, bruises, and bumps are less common in PNES compared to epileptic seizures.
What can be mistaken for PNES?
PNES is a condition where individuals may appear to have generalized convulsions similar to tonic-clonic seizures, or absence seizures or focal impaired awareness. It is often suspected by a physician due to unusual features such as movement type, duration, triggers, and frequency. PNES can be triggered by a specific traumatic event, such as physical or sexual abuse, incest, divorce, or death. Somatic symptom disorders, previously called somatoform disorders, are conditions that suggest a physical disorder but cannot be accounted for by an underlying physical condition.
Conversion disorder, on the other hand, is a physical symptom caused by psychologic conflict that unconsciously resembles a neurologic disorder. It tends to develop during adolescence or early adulthood, but may occur at any age, with it being more common among women.
What is the difference between PNES and psychogenic Pseudosyncope?
Psychogenic apparent TLOC (psychogenic nonepileptic seizures) and psychogenic pseudosyncope (PPS) are two distinct manifestations of a common psychiatric disorder. PNES, which involve pronounced movements, is more well-known, with a reported prevalence of up to 30 in patients in epilepsy clinics. PPS, on the other hand, is rarely mentioned in the literature on syncope and has a lower reported prevalence ranging from 0 to 8.
The gold standard for PPS is a demonstration of the absence of circulatory abnormalities causing cerebral hypoperfusion during an event, which can be induced by tilt-table testing. A clinical suspicion of PPS is a recognized indication for tilt-table testing by the European Society of Cardiology.
Are eyes open during PNES?
A study revealed that 50 out of 52 patients with PNES exhibited consistent eye closure during their habitual seizures. The majority of these patients maintained eye closure throughout the entire duration of the episode, while a few demonstrated a tendency to forcefully close their eyes with accompanying facial frowning.
How do you rule out PNES?
A PNES diagnosis requires a comprehensive medical, neurologic, and psychiatric history, a description from family members, results of prior diagnostic testing, response to antiseizure medications, and a complete medical and neurologic examination. Video-electroencephalography (vEEG) is the gold standard test for identifying epileptic seizures from PNES. PNES do not have abnormal brain electrical activity.
Receiving a new diagnosis can be challenging, and individuals may experience emotions like anger, doubt, sadness, confusion, or relief. It is essential to discuss the diagnosis with a doctor and openly share feelings about PNES with the medical team and family to support the acceptance of the diagnosis and finding the best treatment.
What is the aura before PNES?
Patients with PNES often report auras, which are common in patients with focal epilepsies. This can lead to incorrect diagnoses and unnecessary treatments. ScienceDirect uses cookies and requires consent to continue using them. Copyright © 2024 Elsevier B. V., its licensors, and contributors. All rights reserved, including text and data mining, AI training, and similar technologies. Open access content follows Creative Commons licensing terms.
How to know if someone is faking a seizure?
Psychogenic seizures are characterized by rhythmic and purposeful movements, including full-body tonic-clonic-type motions and organized vocalization, such as talking or crying. These features suggest the possibility of a psychogenic non-epileptic seizure (PNES).
📹 How to Diagnose Nonepileptic Seizures (PNES)
In USA, please call the clinic This video discusses the diagnosis of Psychogenic Nonepileptic Seizures (PNES). Part 1: What is …
Not even 60 secs in & Im in tears b/c after 20+ years of gaslighting/guilt/shame by doctors and family, Ive spent the day seizing, debating going to the ER, and talking myself out of all the that those feelings. I should know its not my fault, and trying to control the seizures only makes them worse, but hearing it from a medical professional is healing. Thank you.
I have suffered from very strange “seizures” since i was 19. The symptoms are difficult to explain. They usually occur in clusters when I am very tired or on the verge of sleep. I am enveloped by a strange feeling of deja-vu and temporarily forget the time and date. It usually results in depression and anxiety. I always am able to keep on top of it, that is present a front to people around me so they don’t know what I am going through at the time. It is such an unreal experience I find it difficult to articulate the sensation. Can anyone else relate to this?
My boyfriend had this. He would be taken to the hospital and they said he was faking it. His body would kinda jerk up almost as if he could t control it. He would. Try to say not safe or not fake in a breathless voice. It made me so mad that they treated him like he was a liar wasting their time. Shame we dont talk anymore cause id love to show him this
I’m only 40 days into my PNES diagnosis and I’m trying to learn as much as possible. Thankfully the absolute worst seizure’s I’ve had multiple times per day 2-3 days in a row…. Was at the epilepsy testing hospital. I’m really hoping I don’t have anymore seizures that are that severe when I’m out living life or at home alone…. It’s terrifying cycling in and out of awareness when it’s happening . It’s so painful, exhausting, and shatters your confidence in your body working properly.
I’m 14, I got diagnosed with PNES when I was about 12 and a half. I’m a freshman now, and this past week the school was like “Hey, you’re malfunctioning again, move you legs, get up and walk, or we will send you to a mental hospital!” Even though I couldn’t walk or control my legs. And they put me on medication for it so, hey, here we go i guess
I showed my neurologist my seizure diary. It showed that if I took 1,500 Levetiracetam twice a day then I will only have a maximum of 3 seizures a month during my menstrual cycle. If I kept taking 750mg of Levetiracetam then I would have 5 or 6 seizures a month and may also have one focal to bilateral tonic clonic seizure. Yet the funny thing is because I work in a noisy environment with announcements, loud music and angry customers that would trigger the seizures due to my autism but find being on the medication is helpful because if I didn’t take it then I would have daily seizures and be unable to work.
My doctors and nurses called them pseudo seizures, which really bothered me. The neurologist finally called it PNES. She said it was due to anxiety and put me on a lot of Clonazepam (Klonopin). I was still having anxiety and seizures, until I was put on Adderall for my ADHD and all my anxiety and seizures went away. Well for now at least.
I have these seizures and ones were i just stare but mind gone blank, been taking them since the age of 14 and still have them. I was once under observation for a month in our local hospital with gadgets on my head and a monitor on my wrist, this was many years ago and i still take them. First they introduced me a psychiatrist thinking i was either faking them looking for attention, i do not take any medication for them but i was once on Epilim, then Epinutin, and another which i can’t remember since it was a long time ago. But now i am on antidepressants because of it all i was on one 0.5mg and now i take two 45mg a night.
Hi Doc, I was diagnosed with juvenile myoclonic epilepsy 20 years ago when I was 18. I started with myoclonic jerks at 16 then had a tonic clonic at 18. Ive been on various meds over the years, but the side effects have made me very sick. I only had tonics clonics when I was 18 and the aurus that would accompany them went at age 24. I am left with myoclonics, but worried these may turn into tonic clonics if I altogether leave the meds (currently on Briviact 25mg a day). However, I have had over 10 EEGs and MRI’s over the years that have all come back normal, 1 was sleep deprived, 1 was for 24 hrs and on no meds. All neuros ive seen are baffled. Is this possible, thoughts?
I was given my diagnosis in the emergency room and I didn’t really receive much info from the doctor themselves (I was passed out from the hospital drugs and they just gave my mom a packet)… There weren’t really any follow up appointments then. But I had numerous appointments a few years before for doctors trying to figure out tf I had lol. I moved to a bigger city for college and was immediately diagnosed o-O
My EEG’s have always been normal, but I have auras before I seize. I never had seizures until I was 20; however, I remember having auras as a child. I haven’t had a seizure in almost 3 years, but I currently take Aptiom. I was suffering with a severe case of OCD and was severely stressed when I started having full blown seizures. Even tho I had auras, could my seizures be non-epileptic?
When we fail to rest our minds & our bodies, this is the ultimate result. We put far too much mental & physical strain and stress on ourselves and then it’s almost like our conscious selves are “pushed out the way” so that our own bodies can make sense of what’s happening with us. I hate to compare us to digital technology but you notice what happens when our computers have too much information stored inside? Or even when we update our computers, should we use the computer or set it down? We need to rest ourselves. We are suppose to get at least 1 day of rest each week which equals 4 days of rest per month, that ultimately totals at least 48 days of rest per year. If you haven’t received rest in the past 3 years, that’s 48×3 days of rest you’ve missed. & Remember, sleep & rest are completely different. ✨
I had these from 2 up to 19.. then they stopped. Then I had a few in my 20s, but only about 3. Then at 35.. I started getting them again. Then, they stopped for a year. Then, at 39.. they started again. But at 47 they got really bad. I was tested again and to everyones surprise.. they were epileptic. I had brain surgery because they turned into status epilepticus. And one time stopped my heart. That had always been my fear. Now it’s possible. Seizures are NOT to take lightly!!
PNES is still probably the best although the Functional Seizure Disorders would be useful to cover a broad variety of types of PNES that express in different ways…I have read journal articles that describe different neuropsychiatric disorders that increase the likelihood of PNES so perhaps PNES is one type of FSD…?
‘Psychogenic’ is a better name than ‘functional’, because it’s more truthful and the patient knows exactly what’s going on in the doctor’s mind. It’s confusing if the doctor gives a pathological label to non-pathological illness. It can reinforce the psycho-patient in their sick role, and can also lead to genuine neurological conditions getting missed if the doctor is overly biased toward this trendy new FND diagnosis.
The first neurologist I saw, Dr. Stephen Howlett, called my episodes “pseudoseizures” and I felt that he believed I was faking the seizures or I was mentally ill; not just by his words, but by the rude tone he took with me. I have learned much more since that time, and know that Dr. Howlett did a disservice to many of his patients and gave a bad name to neurologists.
had one the other day for the first time so i dont actually know if it fits in the same category as the seizures other people in the comment section have on a regular. Doctors in hosptial believed it was caused by lack of sleep and maybe second hand cannabis consumtion. I was 100% aware of everything that was happening but couldnt open my eyes and was more or less choking for 3 hours. when the ambulance arrived they kept telling me it was only in my head and kept on hurting me by scraping their knuckles against my chest over and over for 10 minutes or so. I felt more and more like it was my fault that it was happening, they didnt seem to believe that im not simulating and i`m actually helpless… this was traumatizing i dont even want to know how it is for the people who have it more often
I was just recently diagnosed with epilesy, i have had seizures when i was younger(i have had only 4 but they stopped nearly 16 yrs ago-no one ever told me what kind of seizures i had, not even the doctors) and i passed out at home nearly a year and a half ago(i felt fine, just a normal morning getting ready for work-no headaches-when i had seizures i could feel them when i was about to have one but i had no feeling of it during the time) i remember feeling stressed about numerous things and when i was making my coffee for the morning i passed out but the strange thing is i woke up about 10 minutes later back in my bed and my right foot was burned on top(from spilled hot coffee), i don’t like hospitals(i saw a loved one i was close with go down fast in 2 close hospitals near me-and i cringe anytime i am near one of them) so i went on it to work and a coworker noticed something off about me(i have been trying to get my driver’s license hence all my stress and i can’t drive until i am okayed by my dmv-waiting for papers to come in for me to fill out by doctors) and i told her what happened and she knew i didn’t like hospitals so i told her i was going to urgent care when i got home(the urgent care doc thought i was drunk/crazy and trying to get attention-i don’t drink or do drugs-i haven’t been on any seizure meds in years and i do have anxiety but i would never do anything like this for attention) and after seeing my pcd(he was trying to put in my head that i was doing all this for attention to) and after having second opinions(several tests including a head mri which were all good results) i had to wait 3 long months to see a neurogist(i was willing to see anyone in that office so i could be checked out right quick but no one was available hence my long wait) it took a while to get a test done due to my med insurance not covering my test(it was a at home eeg article/audio test that i had done a few weeks ago-only had this test done for 2 days) and during the time of all this waiting the doc wanted me to take anti seizure meds just in case(i was having headaches before i started the meds and they are sometimes recurring feel just like tension headaches-my doc lied to me months ago of what all i could take otc in case i was sick or if i had a headache-otc cough meds are fine as long as i am careful of how much i take, otc headache meds have made my headaches worse cause they were messing with my meds-i had no idea and i was furious at the doc cause he told me i could take any otc med but then lied to me saying don’t take this otc med).
Hello, Doctor Omar! A year ago I was diagnosed with epilepsy but last month I had a check up and the results showed that it was not epilepsy. Although, the exams show this results, I usually get off but at the same time is like my brain is active because I wash my dishes or make my bed and later on when Im back is like what happened? My doctor was confused but checking this article it makes me think I have this or not?
At many government clinics in South Africa it is almost impossible to have a proper discussion with your doctor about your condition. We almost never see the same doctor twice because the clinic has a different doctor everyday. We don’t get to decide which doctor we want to see. Many doctors at the clinic that me and my brother have gone to don’t even know why we take the medication. They just simply repeat the prescription without looking through the file or asking questions. Some of these doctors don’t even know about the epilepsy diagnosis. A few doctors will look at the file, ask questions and request blood tests. Some only request drug levels, but one or two doctors will look at liver, kidney and complete blood count details as well.
Hello, thank you for the All Informations. My daugther is 10 years old. Last summer, it was begin with non epileptic seizures. Today it was an Other seizure, she was standing, saw colorful dots and than she dont know and she has wet. Can this be an epileptic seizure? Last summer she has some Spikes in eeg.
I’ve been suffering from PNES since I was 19 and the treatment I got was just being told I had pseudo seizures and shuffled out the door. It took 10 years for someone to actually treat me and diagnose me properly. It came back with a force in the last year or so and it’s destroyed my life. Thank you for creating this content. This will be something I show people who need to know what’s up with me. Great work man and thanks again!
It’s up to the doctors to diagnose and it’s my job to provide the cure! I was a master at mental suppression and keeping my own abuse to myself for years and that’s why I’m becoming the leading expert in PNES! I might only be a psychology student right now but I can still offer up possible solutions!