6th August 2024

Psychogenic non-epileptic seizures

These are involuntary behavioural and/or motor responses to triggers, which may clinically resemble a seizure. The aetiology is not entirely understood, but there is thought to be a likely psychological mechanism. Psychosocial stressors may trigger these events.

Key features that differentiate these from true seizure events include:

• Unusual seizure-type movements – especially side-to-side movement of the head
• Eye closure with resistance to eye opening
• Normal respiratory and heart rates, lack of cyanosis
• Rapid recovery of consciousness following the event
• Long duration
• Normal prolactin and CK after the event (though sensitivity is variable)

Video EEG may be helpful and will demonstrate normal electrical activity during episodes. Neuroimaging is typically recommended to exclude an epileptogenic lesion.

One of the mainstays of management is patiently and supportively explaining the diagnosis to the patient, usually with psychotherapeutic support.