Psychogenic Non-Epileptic Seizures (PNES): Symptoms, Causes, and Treatments

Psychogenic seizures are non-epileptic paroxysmal movements. They constitute quite a challenge to clinical practice. If you want to know more about these crises, read on.
Psychogenic Non-Epileptic Seizures (PNES): Symptoms, Causes, and Treatments

Last update: 20 May, 2022

Seizures are transient paroxysmal alterations that occur unexpectedly and abruptly, caused by abnormal neuronal activity. These seizures can be categorized as epileptic and nonepileptic. Psychogenic seizures are the non-epileptic kind caused by psychological factors. They’re known medically as psychogenic non-epileptic seizures (PNES).

The prevalence of these seizures varies from 17 to 60 percent. They can coexist with epileptic seizures. In fact, an investigation found that the prevalence of psychogenic seizures ranges from 3.6 to 10.8 percent in patients with epilepsy. In turn, epileptic seizures have a prevalence of 12 to 36 percent in people with psychogenic seizures.

Psychogenic seizures

Psychogenic seizures are a set of sudden and immediate changes in behavior, cognition, and sensory perception. They simulate epileptic seizures, but without abnormal neuronal discharge. They’re correlated to a psychological mechanism and not a biological one. For this reason, they’re recognized as psychogenic.

The term psychogenic makes it possible to differentiate this type of seizure from those that are non-epileptic and generated by transient ischemic attacks, migraines, fainting, etc. In these cases, the cause of the crisis has a neurological basis that explains the appearance of the non-epileptic seizure.

Woman with epileptic seizure standing
Dissociative symptoms are the most common in people with PNES.

The main symptoms of PNES are the following:

  • Head movements from side to side.
  • Increase and decrease in consciousness.
  • Asynchronous limb movements.
  • Closed eyes.
  • Dystonic postures.
  • Thrusting pelvic movements.

Psychogenic crises have been associated with a variety of psychiatric disorders. The following are the most evident (Giagante et al., 2007):

  • Affective problems. Comorbidities of depression and dysthymia have been found in PNES patients. In fact, between 40 and 80 percent of the patients studied.
  • Anxiety disorders. Post-traumatic stress disorder of between 35 and 49 percent has been found in patients with PNES.
  • Dissociative disorders. Dissociative symptoms are extremely common in patients with PNES (90 percent).
  • Somatoform disorders. The symptoms of these disorders are associated with the dissociative and conversion symptoms of non-epileptic psychogenic seizures.
  • Alterations in personality. The most common disorders are borderline personality disorder (BPD), dependent, histrionic and avoidant disorders.

Causes and associated factors

The etiology of PNES is extremely diverse. However, it’s believed that they arise as a maladaptive coping mechanism in the face of stress or anxiety. It seems that the psychological conflict resulting from an intolerable existential situation translates into physical symptoms (seizures) that keep stressors out of consciousness (Alsaadi and Marquez, 2005).

The factors that have been most associated with psychogenic non-epileptic seizures are sexual and physical abuse, trauma, neurological abnormalities, family dysfunction, stressful life events, poor interpersonal skills, personality disorders, and avoidant coping. In fact, abuse and neglect are considered the predisposing factors that increase vulnerability to the development of these seizures.

Some precipitating factors that have been linked to PNES include rape, death or separation from a loved one, job loss, accidents, surgical procedures, and natural disasters, among others.

Furthermore, several perpetuating factors such as anger, anxiety, depression, and abuse have also been identified. These factors make it impossible for the patient to regain control of the situation, thus aggravating their seizures.

worried man
Although the etiology of psychogenic non-epileptic seizures is extremely diverse, it’s thought to be a maladaptive mechanism for coping with stress or anxiety.

Treatment of psychogenic non-epileptic seizures

The therapeutic approach and treatment will depend on the individual and their precipitating, triggering, and perpetuating factors.

There are a wide variety of interventions that can be used. For example, behavioral therapy, hypnosis, psychoeducational, and family therapy (Bodde et al., 2009).

Cognitive-behavioral therapy is an excellent treatment option. As a matter of fact, research has found it to be more effective than standard medical care in reducing seizure frequency in people with psychogenic non-epileptic seizures.

There are also other strategies that can be implemented in the PNES intervention plan. For instance, lifestyle changes, antidepressant medication therapy, and interpersonal psychodynamic therapy.

These strategies not only seek to reduce the seizures but also to improve the psychiatric comorbidities with which they’re associated. They also help patients recover functionality in their daily life and improve their quality of life.

To conclude, non-epileptic psychogenic seizures include paroxysmal changes in behavior, consciousness, and body movements. They resemble epileptic seizures but aren’t supported by electrophysiological changes in the brain.

Their diagnosis and treatment are quite a challenge. That’s because their exact cause hasn’t yet been established. In addition, a wide variety of psychiatric and psychological problems can end up converging on the disorder.

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