Dissociative seizures look very similar to other types of seizures but are not actually seizures by definition. In evaluating this relationship, the dissociative experiences scale des has been used, which is a self. Dissociative seizures markedly impair quality of life. These are referred to briefly in this section, but are fully described and elaborated in the basic and specific cbt domains of the cbt. Functional neurological disorders fnd are common and associated with significant morbidity and healthcare costs. People present with episodes that resemble seizures, and most have received a diagnosis of epilepsy and treatment for it. The approach to patients with nonepileptic seizures. The cognitive behavioural therapy versus standardised medical care for adults with dissociative nonepileptic seizures codes trial is an evaluation of a specifically tailored psychological. These expressions are quite unfortunate as they convey a stigma and instigate the idea that people with histrionic personality disorder suffer from dissociative seizures. Nonepileptic seizures happen because of problems with handling thoughts, memories, emotions or sensations in the brain.
The seizures can look like any kind of epileptic seizure. Cognitive behavioural therapy vs standardised medical care. Though research and publication activity is high, advances in knowledge and insight seem only moderate in recent years. Dissociative seizures, nonepileptic seizures nes epilepsy. Conversely, psychogenic ness are thought to be caused by the mind and have been known by the terms. Assessment of patients with psychogenic nonepileptic seizures. Cognitive behaviour therapy cbt for dissociative non. Dissociative psychopathology, nonepileptic seizures, and. Dissociative seizures are one of the three common disorders which, between them, account for over 90% of clinical presentations with transient loss of consciousness. You may feel as if you are detached from your surroundings or as if the room is moving around, or just get a feeling of unreality. The potential complications of such diagnostic delays include the adverse effects of antiepileptic medications, iatrogenic complications e.
Dissociated will be a feature length documentary about dissociative seizures, also known as nonepileptic attack disorder nead or psychogenic nonepileptic seizures pnes. Dissociative seizures, often having similar manifestations to that of seizures in the absence of paroxysmal neuronal discharge, pose a significant burden on the patients, their family and the healthcare system. The potential complications of such diagnostic delays include the adverse effects of antiepileptic medications, iatrogenic. Ictal symptoms of anxiety, avoidance behaviour, and. E1745 march 2011 with 4,359 reads how we measure reads. In the usa, 2 to 33 of every 100 000 persons suffer.
Pnes presenting symptoms involve a wide array of nervous system functions, including changes in behavior, motor activity, sensation, cognitive, and autonomic functions. Treatment may involve psychotherapy, stressreduction techniques such as relaxation and biofeedback. Up to one fifth of patients who present to specialist clinics with seizures do not have epilepsy. The majority of such patients suffer from psychologically mediated episodes.
Dissociative seizures are commonly recognized as both a challenging and a poorly understood condition. Research and treatment must focus on the underlying psychiatric disorder. Outcome was better in patients with greater educational attainments, younger onset and diagnosis, attacks with less dramatic features, fewer additional somatoform complaints, and lower. Mellers department of neuropsychiatry, maudsley hospital, denmark hill, london up to one in five people diagnosed with epilepsy will turn out to have dissociative seizures ds psychologically mediated episodes of altered awareness andor behaviour that may. There are many different names for nonepileptic attacks. Psychogenic seizures are often underdiagnosed and epilepsy is very often overtreated which leads to multiple financial, social and stigma related difficulties. Other names you may hear are nonepileptic seizures nes, nonepileptic events, psychogenic seizures, functional seizures, dissociative seizures, pseudoseizures or pseudoepileptic seizures.
Cognitivebehavioral therapy for psychogenic nonepileptic. Only moderate advances in dissociative seizure research have been made recently. Psychogenic nonepileptic seizures pose a management problem psychogenic nonepileptic seizures pnes, while superficially resembling epileptic seizures, are not accompanied by the abnormal electrical discharges associated with epilepsy and cannot be explained by other medical conditions. It can make you feel strange and lightheaded and more likely to have a seizure. History and careful observation and examination are critical to diagnosis, as investigations will often be normal or noncontributory. May 30, 2016 dissociative or psychogenic nonepileptic seizures pnes are involuntary episodes of movement, sensation, or behaviors vocalizations, crying, and other expressions of emotion that do not result from abnormal brain discharges. The seizure happens because their emotional reaction causes a physical effect. An additional aim was to assess possible relationships between dissociation, traumatic experiences, posttraumatic symptoms and seizure manifestations in this group. A guide for patients and families, selim benbadis and leanne heriaud suggest that the competent treatment of pnes will result in the elimination of seizures in 60 to 70 percent of adults, and the results for children and adolescents may be even more impressive. Many largescale epidemiological studies led to biased results due to this deficit in their methodology.
Patients with fnd often present acutely, particularly with dissociative seizures resembling epilepsy or persistent weakness resembling a stroke. Psychogenic seizures increased risk in veterans relatively high rates of tbi 19% of oefoif increased seizure risk most common putative cause for pnes relatively high rates of ptsd estimates of 20% established risk factor for pnes compensation 58% 19% 8% 6% 9% somatoform conversion dissociative malingering factitious other. A randomised controlled trial neurology this booklet was provided in the study to participants in neurologyspecialist epilepsy clinics to explain what dissociative seizures are. Studies using the sdq20, which mostly comprises items pertaining to pseudoneurological phenomena e. The person splits off or dissociates from their feelings about the experience because it is too difficult to cope with. They are of psychological origin, and are one type of nonepileptic seizure mimics. However, the treatment of such patients is always challenging and frustrating due to poor response to the routinely used interventions in most situations. A complete neurodiagnostic evaluation along with an awareness of this relationship is needed to provide appropriate care for this patient population. There are indeed some distinct similarities in the signs for both some types of seizures and a dissociative disorder. The myoclonic seizure itself is a rare phenomenon and when functional movement disorder presents like myoclonus then its extremely difficult to pinpoint the exact cause. There are many different names for dissociative seizures. Aug 26, 2016 in their article psychogenic nonepileptic seizures. Dissociative seizures, or psychogenic nonepileptic seizures, are involuntary experiential and behavioural responses to internal or external triggers that superficially resemble epileptic seizures but which are not associated with the abnormal electrical activity associated with epileptic seizures. There is an average delay of seven years before dissociative seizures are correctly diagnosed.
Psychogenic nonepileptic seizures pnes are sudden, involuntary seizurelike attacks that, unlike epileptic seizures, are not related to electrographic ictal discharges. Dissociative non epileptic attacks are disabling and frightening attacks that look very similar to epilepsy. Dissociative seizures are paroxysmal episodes of altered behaviour resembling epileptic seizures, however, there is no underlying organic cause, including epilepsy. Instead they are psychologically determined and, as patients with pnes may be misdiagnosed as having. Treatment advice for dissociative attacks nonepileptic attacks seizures this document is reproduced from. From what i have read, a dissociative state sounds very much like a petit mal seizure. Many people with nonepileptic seizures have been given antiepileptic drugs. To examine anxiety related seizure symptoms and avoidance behaviour in adults with dissociative psychogenic nonepileptic seizures ds in comparison with a group suffering from partial epilepsy. Dissociative convulsions nonepileptic seizures recent estimates suggest that between 9% and 50% of patients referred to specialist epilepsy centres have paroxysmal events that, despite resembling true epileptic episodes, are actually nonepileptic. Such drugs are only useful if people have both nonepileptic and epileptic seizures. These events cannot be controlled by the people who have them.
Dissociative seizuresfrom clinical picture to the treatment. With grateful thanks to northumberland, tyne and wear nhs trust for permission. All the links in the website and all the downloadable information in one place. Their close superficial resemblance to epileptic seizures makes them hard to diagnose. Pdf cognitive behavioural therapy versus standardised. Using hypnotherapy to treat psychogenic nonepileptic seizures. Dissociative convulsions, a prominent form of dissociative conversion disorder formerly known as hysteria, are a common and elusive differential diagnosis from epilepsy. Abdominal breathing is a way of controlling your breathing.
A total of 444 9% patients with epilepsy and 222 9% patients with dissociative seizures were found to have mild sleep. Jun 27, 2015 the evidence base for the effectiveness of psychological interventions for patients with dissociative nonepileptic seizures ds is currently extremely limited, although data from two small pilot randomised controlled trials rcts, including from our group, suggest that cognitive behavioural therapy cbt may be effective in reducing ds occurrence and may improve aspects of psychological. Unlike epilepsy, dissociative attacks are not due to abnormal electrical discharges in the brain or another nervous system disease. Dissociation in patients with dissociative seizures.
This document is designed to make this information easier to print off. A case of dissociative seizures presented like myoclonic. The recommendations in this guideline represent the view of nice, arrived at after careful consideration of the evidence available. How can a person tell the difference between a seizure and a dissociative episode.
Dissociative seizures alone do not constitute a morbidity in the sense of a diagnostic group, and, strictly speaking, the notion of comorbidity in this context is simply wrong. Characteristics of 698 patients with dissociative seizures. Dissociative seizures look very similar to epileptic seizures but are very different. Most commonly the episodes in question are convulsive whole body shaking and resemble generalized tonicclonic grand mal seizures, but they can be less dramatic and mimic milder types of seizures partial seizures, absence seizures, myoclonic. In the lesson, we will learn more about dissociative seizures and what causes them. A dissociative seizure is usually provoked by emotional stimulation or a stressful situation of which neither the patient nor the people around him are usually aware. Abnormal sleep in patients with epileptic or dissociative. Aug 2010 and is designed to be used together with that website. If you would like to print a poster advertising the website for your clinic room. Some 10% of patients with dissociative seizures have epileptic seizures, whose onset almost always precedes that of the dissociative seizures. General psychiatric assessment instruments do not cover dsmiv dissociative disorders.
Pdf characteristics of 698 patients with dissociative. Any promising research, be it in the field of etiology, pathogenesis, treatment, or prognosis, would indeed have to focus on the underlying psychiatric morbidity. Other names you may hear are nonepileptic seizures, nonepileptic attacks or events, nonepileptic attack disorder nead, psychogenic seizures, functional seizures, pseudoseizures or pseudoepileptic seizures. They can be called nonepileptic attacks or nonepileptic seizures.
Patients with predominantly hyperkinetic dissociative seizures had a shorter disorder duration prior to diagnosis in this study than patients with hypokinetic seizures. Diagnosis and management of dissociative seizures john d. This paper describes the diagnostic evaluation of seizure disorders, including clinical assessment and the role of. Introduction to seizures and epilepsy va epilepsy basics. Selective literature search in pubmed and psycinfo. In this lesson we will learn about dissociative seizures and what symptoms are associated with them. Information for patients taking control of your non. Often dissociative seizures are how the brain reacts to thoughts or feelings related to present and past experiences. Psychogenic nonepileptic seizures pnes are events resembling an epileptic seizure, but without the characteristic electrical discharges associated with epilepsy. Many people with nonepileptic seizures or anxiety attacks find that their breathing becomes difficult or quick and shallow before a seizure.
Between 3040% of patients admitted to our hospital for attacks that do not improve with medicines turn out to have non epileptic seizures, and are taken off medications. This documentary is the vision of clea martin vargas who decided to create it after her friend was diagnosed with nead. Comparing different treatments in reducing dissociative seizure occurrence codes the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. There is little scientific support at this time for the hypothesis that dissociative disorders are caused by an epileptic mechanism. Pnes are also known less specifically as nonepileptic attack disorder nead and functional neurological symptom. Jul 22, 2009 from what i have read, a dissociative state sounds very much like a petit mal seizure. Antiepileptic drugs have no effect on nonepileptic seizures and they often cause side effects. Nationally, it is estimated that 23 people in 10,000 suffer from these attacks. Epilepsy incidence rates by age 10 100 0 10 20 30 40 50 60 70 80 all epilepsy types age years incidence per 100,000 data from rochester, mn 197584 hauser wa et al. Dissociative seizures happen for psychological reasons rather than physical ones. Persons with dissociative seizures constitute a mixed group with a wide variety of predisposing, precipitating, and maintaining factors. Dissociative or psychogenic nonepileptic seizures pnes are involuntary episodes of movement, sensation, or behaviors vocalizations, crying, and other expressions of emotion that do not result from abnormal brain discharges. Comparing different treatments in reducing dissociative.
294 472 969 31 732 1003 86 538 23 1462 1352 1433 1463 458 344 477 1363 272 905 665 952 491 276 665 315 386 1434 807 9 543 1161 61 333 266 1129 1374 1298 60