Dissociative disorders that appear as seizure-like episodes are commonly known as Psychogenic Non-Epileptic Seizures (PNES). Although they physically resemble epileptic seizures, they do not result from abnormal electrical activity in the brain. Instead, these episodes are linked to psychological and emotional factors such as stress, trauma, or unresolved internal conflicts.
The term pseudoseizure is older and less preferred today. Modern terminology uses PNES or functional seizures to describe these events.
How Dissociative Seizures Differ From Epileptic Seizures
While both conditions may look similar externally, their underlying mechanisms differ:
Epileptic seizures occur due to electrical disturbances in the brain.
PNES occur due to psychological processes and are not caused by electrical changes.
Because the outward symptoms can look identical, many people are initially misdiagnosed with epilepsy.
Common Symptoms of PNES
Symptoms can vary widely, but may include:
Sudden shaking or tremors
Loss of responsiveness or awareness
Collapse or unresponsiveness
Crying, shouting, or emotional outbursts during an episode
Non-rhythmic movements or side-to-side head shaking
Prolonged episodes without typical post-seizure confusion are seen in epilepsy
These episodes are involuntary, meaning the person is not consciously controlling them.
Causes and Contributing Factors
PNES is associated with psychological and emotional factors, including:
Past or ongoing stressful life events
Emotional trauma
Anxiety or mood disorders
Difficulty managing emotional distress
Family or relationship conflicts
History of adverse experiences
These pressures can manifest physically when the mind becomes overwhelmed.
Who Is More Likely to Experience PNES?
Although PNES can occur in anyone, clinical observations note:
Higher occurrence in women
Higher prevalence among individuals with anxiety or depression
Increased likelihood in those with a history of trauma or emotional distress
Some individuals may experience both epilepsy and PNES, complicating diagnosis
How PNES Is Diagnosed
Diagnosing PNES requires careful assessment because of its similarity to epileptic seizures. The gold-standard diagnostic tool is:
Video EEG Monitoring (VEEG)
This test captures brain activity and a video recording simultaneously.
During an event, if there is no epileptic electrical activity, the diagnosis leans toward PNES.
Accurate diagnosis prevents unnecessary treatment with anti-seizure medications.
Physical exams, psychological evaluations, and a detailed medical history also contribute to a proper diagnosis.
Treatment Options
Treatment focuses on addressing underlying psychological factors, rather than the physical symptoms.
1. Psychological Therapy (Primary Treatment)
Cognitive Behavioral Therapy (CBT) and other structured psychotherapies help individuals understand emotional triggers, develop coping mechanisms, and reduce episode frequency.
2. Managing Stress and Emotional Conflicts
Therapies may include:
Trauma-informed therapy
Stress management techniques
Mindfulness-based approaches
Emotional regulation skills
3. Collaborative Care
A coordinated approach may involve:
Medical evaluation for accurate diagnosis
Mental health support for therapy
Continuous follow-ups to track progress
This multidisciplinary approach often produces the best outcomes.
Prognosis and Recovery
Many individuals experience significant improvement after receiving a clear diagnosis and starting appropriate therapy. Recovery depends on:
Severity of underlying psychological issues
Acceptance of the diagnosis
Engagement with therapy
Coexisting neurological or psychiatric conditions
With proper care, patients can achieve reduced episodes, improved emotional regulation, and better quality of life.
Expert Care With Dr. Vatsal Suchak
If you or a loved one experiences seizure-like episodes that are difficult to diagnose or manage, seeking specialized care is essential. Dr. Vatsal Suchak provides expert evaluation and treatment for dissociative disorders and psychogenic seizures, offering a structured path toward recovery. With professional guidance, patients can receive accurate diagnosis, personalized therapy, and comprehensive support to improve their overall well-being.
FAQs
Dissociative disorders, specifically pseudoseizures or psychogenic nonepileptic seizures (PNES), are seizure-like episodes caused by psychological factors rather than abnormal brain activity. They resemble epileptic seizures but have a different underlying cause.
The main difference is that epileptic seizures result from electrical disturbances in the brain, while pseudoseizures are triggered by emotional or psychological stress. Diagnosis often requires video EEG monitoring.
Pseudoseizures are commonly linked to psychological stress, past trauma, anxiety, depression, or emotional conflicts. These factors can manifest physically as involuntary seizure-like episodes.
PNES can occur in anyone but is more commonly observed in women and in individuals with a history of trauma, anxiety, or depression. Some patients may also have concurrent epilepsy, which can complicate diagnosis.