Pseudoseizures vs. Seizures
The title says it all: Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures.
First, the bottom line:
50/52 patients with pseudoseizures closed their eyes during their "seizure," while 152/156 of actual epileptics opened their eyes during their seizures. That's a sensitivity of 96% and a specificity of 98%. That's gold.
Now, the details:
The authors took 234 consecutive "seizure" patients, hooked them up to video EEGs and stopped their medications. There were 938 total ictal events in 221 patients. 52 (23%) had pseudoseizures, and 156 (70%) had eplieptic seizures. There was a 3:1 female predominance in the pseudoseizures, no difference in epileptics.
In the epileptics, there was rhythmic eye blinking during tonic-clonic activity, and the eyes closed after theseizure was finished.
An interesting corollary to this is when pseudoseizures occur in an actual epileptic: quoting the authors, "the simple question of eye opening or closure can help differentiate between the two types of events. One previous study found that patients with both types of events tended to have their eyes closed during PNES and open during ES.(6)"
Outstanding.
Of course, this is isn't going to mean much to psychiatrists, apparently.
A questionnaire was put to neurologists (N=39) and psychiatrists (N=75) about the utility of video EEG in diagnosing pseudoseizures. 70% of the neurologists, but only 18% of the psychiatrists, thought that video-EEG was accurate "most of the time" in diagnosing pseudoseizures. 12% of the psychiatrists (no neurologists) said it is accurate "almost never." (3% of the psychiatrists gave no clear response. Why doesn't that surprise me?)
So here are some other differentiating symptoms:
In seizure patients, there is a crescendo-decrescendo quality to the spike-wave frequencies on EEG. In pseudoseizure patients, however, the frequency is the same from beginning to end, and it comes on suddenly as if a switch was flicked. The spike-wave on EEG is actually motion artifact, and typically runs around 4 Hz, while epileptics have frequencies that vary between 4-25 Hz.
In a study of 40 pseudoseizure vs. 40 matched normal controls, the pseudoseizure group had more left handers, reduced strength and speed in both dominant and non-dominant hands, and reduction in the dominant hand advantage in strength and speed (i.e. both hands performed equally badly-- the dominant hand wasn't a little better.) Interestingly and importantly, the authors did not think this was due to faking or psychological factors, but felt that it was due to actual neurologic impariment in bilateral pathways: 65% had had a closed head injury, 27% had had physical abuse, and 17% had had a history of substance abuse. 40% had an IQ less than 90!
A study in epileptics vs. pseudoseizure patients trying to determine how long after admission to a video EEG unit it takes for patients to have events (answer: 88% had it on day 1) also found that urinary incontinence, focal neurologic exams, and tongue biting were about the same in both groups. But more epileptics had events less than one minute, and more pseudoseizures lasted > 5 minutes (and very few (13%) lasted less than one minute.)
Slightly different results were found in another study: 11/28 pseudoseizure patients had them on day 1, but 9/28 needed an average of 5 days. 19/28 had an induced pseudoseizure to IV saline challenge within 3-7 minutes. But still-- 3 days should be enough for most patients.
And alexithymia is of no value. It is found more often in epileptics and pseudoseizure patients equally, though still more than expected in the community. A larger, controlled trial had found a similar inability for alexithymia to differentiate: alexithymia was very common in epileptics (76%) and pseudoseizures (90%). Thus, it is likely that alexithymia is a coping strategy, and not an independent trait.
Addendum 11/5/06: I did find an interesting (Greek) study finding an excess of seizures on full moons (34% vs. about 21% for the other phases.) Importantly (and in contrast to suggestions by other studies) these were not pseudoseizures, because all patients were monitored. The authors speculate either electromagnetic/gravitational effects (hey, it could happen) or an interaction between the intrinsic seizure threshold and the environment (i.e. you can change you rown threshold.)
Recommend to a Friend
October 6, 2006 9:47 PM | Posted by : | Reply
Are psuedoseizures real? And if so , do they require seizure medications? Can they be brought on by Post Traumatic Stress Disorder?
Score: -1 (1 votes cast)
October 7, 2006 4:27 PM | Posted by : | Reply
Real? well, they really do shake or stare off into space. A "true" pseudoseizure is a conversion disorder: that means that there is no physical pathology (in this case, no actual electrical problems in the brain) but the patient is creating the symptoms unconsciously. In other words, they're not faking it, they think it's real. If the patient were actually faking, it wouldn't be a "pseudoseizure," it would be faking (malingering.) If the patient is conscious during the event, and realizes that it is anxiety, then that's not a pseudiseizure either-- that's anxiety.
In the "old" days, conversion disorders were spontaneously paralyzed limbs with no pathology.
In actual practice, however, most people with conversion disorder do have an inkling that the disorder isn't physical, but not enough insight to make it go away.
Some clinicians relate this to alexithymia: in inability to voice your emotions. The patient is angry, doesn't "understand" it as anger, so instead of manifesting the emotion as yelling, redness in the face, etc, they manifest it as a "seizure." Isn't the psyche great?
The treatment is to make the causes of the pseudoseizure conscious. (e.g. showing them that they really are angry, etc.) Meds don't help the pseudoseizure, they help the surrounding emotions.
Score: 0 (0 votes cast)
October 7, 2006 5:39 PM | Posted by : | Reply
have been diagnosed with pseudoseizures cannot find a doctor who will help or listen to me even tho it occurs in front of them i need real medical help i can smell fluid and feel fluid in head: ears ringing : 3 hole lumbar punture in 99 :brief vision loss:and ridicule by doctors when i tell them of symptoms i have my medical records showing eeg,lp,ect i am low income and need help please thank you please respond soon
Score: 0 (0 votes cast)
July 14, 2007 5:34 PM | Posted by : | Reply
I'm very interested in these results, but a bit baffled as to what they're likely to mean for my husband, who's been suffering from seizure-like events for the last year. He was placed on 60mg prednisone last August for a flareup of ulcerative colitis, which he's been dealing with for ~10 years now. Five days into the prednisone, he had a seizure-like event with eyes open (they were rolled back into his head for part of the time, but his eyes were open and blinking throughout); I'm not a medical professional, but I observed it, and it sure looked like a generalized tonic-clonic seizure to me. These events continued while he was on the prednisone, though they decreased in frequency and severity as the prednisone dosage dropped. All of them occurred with eyes open, except the ones which occurred while he was asleep. A neurologist ordered an EEG, which showed no evidence of epilepsy; the neurologist suggested he might have a conversion disorder (and had a rather dismissive attitude throughout; he seemed to think my husband was making this up).
The seizure-like events continued, though less frequently, after prednisone was discontinued. However, the flareup didn't go into remission, and he was hospitalized in February. IV salumedrol (methylprednisone) was administered while he was in the hospital; unfortunately I forget the dosage. Less than 36 hours into methylprednisone therapy, he had another seizure-like event, this one the most severe so far. It was witnessed by several nurses, and the neurologist ordered another EEG, but there was still no evidence of epileptic activity.
He hasn't yet had a video EEG (if that means a 24-hour inpatient EEG observation). During and after the February hospitalization they switched from methylprednisone to hydrocortisone, and he's off the hydrocortisone now, but these events still occur, about one a week. Very few of them are longer than a minute, and I don't think any of them have lasted longer than three minutes (the one in the hospital was the longest, IIRC). They're all eyes-open, as well.
We're rather at a loss as to what to do next, so if you can offer any suggestions, I'd be most appreciative; I've left my email address, which you're welcome to redact if you wish.
Score: 0 (0 votes cast)
September 30, 2007 7:05 PM | Posted by : | Reply
I have had these psuedo seizures for 7 years now and at first i dismissed the idea that I was stressed. Now this is really affecting my life, somedays I can't leave my house or go out alone. Still trying to get where this is coming from and why
Alone's response: pseudoseizures don't "come" from anywhere, and especailly not stress. They are a type of reaction to things. In other words, they are less like "real" seizures and more like anger, or fear, or nervous stomach, etc. It's a way of reacting to stimuli that one can't process in another way. For example, if something bad happens to me that makes me feel helpless, my reaction might be to shoot it or someone. But another person might not have the emotional "range" to come up with anger, or despair-- so they (for example) shut down, or have a pseudoseizure. Pseudoseizure is a "conversion disorder." You don't cure it; you unlearn it. Also look up alexithymia.
Score: 0 (0 votes cast)
December 2, 2007 1:10 PM | Posted by : | Reply
kimberly,you r so wong.Pseudoseizures is a big factor of stress.I know because i live wth these.i have seen 6 different doctors confirm that and agree that stress is a huge factor
Score: 0 (0 votes cast)
December 2, 2007 1:11 PM | Posted by : | Reply
kimberly,you r so wong.Pseudoseizures is a big factor of stress.I know because i live wth these.i have seen 6 different doctors confirm that and agree that stress is a huge factor
Score: 0 (0 votes cast)
April 4, 2008 12:26 PM | Posted by : | Reply
i was told i was having pseudoseizures.
they were wrong
i have POTS.
postural orthostatic tachycardia syndrome
we just had to be determined. last hospital visit solved it :)
they did autonomic testing.
POTS causes tremors ( what we were calling seizures )
it causes sooo much.
read about it.
most pts with this are first diagnosed w/ some psycological problem.
Good luck to all of you
Score: 0 (0 votes cast)
December 3, 2008 1:26 PM | Posted by : | Reply
I am 32 and have just started having these pseudoseizures. My whole body hurts when I have these. I do get upset and now I am starting to forget things leading up to the seizure. The right part of my head hurts and it is scary. An interesting thing is I am left handed
Score: 0 (0 votes cast)
July 19, 2009 7:41 AM | Posted, in reply to , by : | Reply
my psedudoseuzures usually start the same way each time. I will go for a while with head hurting. my head never hurts usually. Also real stressed out but im on med for that and it has helped real well i recently went thru surgery and did not take my med the morning before cause i would be receveing something at the hospital and i was afraid that i would receve too much. my bad they could have fixed it i just didnt tell them cause i thught they wdould thought i had 2 heads. i went into a sezure right after surgery. I do want to say, I have been treated so badly when you even mention the word psedusosuzures. you are faking it they are so wrong i cant control it i have got to the point to where i can tell when it is comeing on sometimes, This is what happens to me my head hurts the blood vessels in my head pop out this might happen a day or 2 before , I get the feeling like i dont know where im at , blank stare and cant talk but can hear every thing that is where i get hurt, and hear what everyone is saying about me afterwards I have to use the bathroom urnate so meany timesa after the whole thing is over. I also jerk and usually my eyes and right or left side of my body and arms if it is real bad my whole body will jerk my head realy hard. Im sorry this is for real and too all the good people that never hurt anyone except there self i feel for you the medical feild that i delt with you are a only feeling sorry for you self and give you a plecebo to fake you well that doesnt work just make you fell not well at all
Score: 0 (0 votes cast)
August 6, 2009 3:24 PM | Posted by : | Reply
i have both complex partial seizures and pseudoseizures and as far as the way they happen it is the same the differance to tell what is what is the doctors notice my eyes and my feet movement.I am taking 3 seizures meds and have gotten better control of my cp seizures however if I start with a pseudoseizure I will more than likley move into a cp seizure. That is what makes it hard to get everything under control.
Score: 0 (0 votes cast)
August 25, 2009 12:16 AM | Posted by : | Reply
pseudoseizures are pysical, and this should not be discounted. The pain and involuntary movement is the same, wheather it is a pseudo or epileptic seziure. Patients with pseudoseizures are more commonly awake for them. Therefore you could say the event is more tramatic. Yes epileptic seizures are tramatic but the patients normally don't remember the event. Telling a patient that has pseudosiezures that they are not real does not help. Since they are a physical manifestation. Therfore they are physical, and are seizures!!
Does anyone else find this problem? people dicounting they are real?
Score: 0 (0 votes cast)
August 31, 2009 11:19 PM | Posted by : | Reply
My 17 year old daughter was diagnosed with pseudoseizures after a video EEG confirmed that what she was experiencing was not an epileptic event. This happened in early June after experiencing them for the first time 3 consecutive evenings. It started as uncontrollable full body tics which we assumed were related to Tourettes which she was diagnosed with a few years ago. The TS diagnosis never seemed quite right to me since the tics she started having came very suddenly with no prior history and she did not ever have vocal tics. The seizures have continued now for almost 3 months and have ranged from occuring several days in a row, to 3-4 weeks apart, to now multiple times per day over the last 2 weeks. She is not conscious once the attack starts and they now only last a few minutes, but typically she will wake up and have another couple within another minute or so. Lately, she has woken up confused and disoriented. I am frustrated with the treatment she is getting, but not sure where to turn for an expert in this area. She is getting ready to enter her last year in hight school and looking forward to college next year, so this is certainly adding more stress to the situation. Thanks for any advise.
Score: 0 (0 votes cast)
October 4, 2009 8:32 PM | Posted, in reply to , by : | Reply
My friend is in the hospital right now for seizures--I just started reading up on pseudoseizures and it fits her to a tee!! The neurologist came in, did an EEG, did not find any activity, asked me if she had trauma in her life-ie:being molested, beaten, raped.....When I said yes, He said, "Oh-well she's not having seizures, I'm going to discharge her."!!! As I was wheeling her---Wheeling her to my car, she started having seiures so the ER nurses brought her in and readmitted her!!! She is in tears, calling me, crying, begging me to take her home, that the nurses and staff are so rude and neglectful, then she's alone and scared and seizing--she's not allowed to get out of bed to go to the bathroom because she's on sz precautions and they are afraid she will fall and get "really hurt". She wants to leave AMA, but insurance will stick her for the bill!!--CPS even took her 3 children away!! 17 yrs old, 14 yrs old and 10 yrs old!!! She is my best friend of 20 yrs-since high school......Does anyone know a good hypnotherapist?? Possibly that contracts with medicare?? She is not faking these seizures, she needs help--her life is being torn apart.
Score: 0 (0 votes cast)
November 2, 2009 1:50 PM | Posted by : | Reply
My problems started on May 5th, 2009. I became very dizzy and had to leave work, the dizziness perstisted for months. During these months this is what took place. My PCP sent me to see a ENT(ear, nose & throat)specialist. They found nothing. I also had a MRI and that is when I had an 'episode'. Everything went all out of perspective, I could no longer walk, the techs did not know what to do. Then I had my appt. with a nuerologist. He took all my info and scheduled me for a EEG. The EEG came back abnormal, but 10 minutes after is when things got out of wack! Although little things did happen during the EEG, and the tech asked me what I was feeling, so I told her. After I got out of the bathroom everything got really slow. My doc and the EEG tech were down the hallway, it looked like they were 500 feet from me. The Doc asked me 'how are you feeling?' I responded with 'I don't know' and started to fall. They caught me and monitored me for 2 hours. I lost my ability to speak clearly and smoothly, for almost 4 days and the doc had said something bout anti-seizure meds. The next week I started them, instead of seeing things all warped they started to look normal slowly. Then shortly there after I ended up having a huge 'episode' that lasted for hours. Prior to that I was at Hospice cause my Grammie was dying, and I was waiting to get ready for church, and was sitting in a rocking chair, then it started, I started shaking all over and could not stop, the nurses called the Doc that was there, he stated 'she is having a grand-mal, call 911'. So that is how it went, then the ER doc did not want to admit me, my Aunt said 'Doc would you send you're loved one home like that?' He shook his head no so they admitted me. Finally after 5 hours these things stopped and after they shot me up with who knows what I was finally able to sleep. I spent 4 days in and finally day by day they slowed down. The docs there said they were from stress I was not dealing with, although I knew my Grammie was gonna be with Jesus when she passed she was 94 yrs old. I have no stress and they keep telling me I need to see a therapist. Whatever it is that happens(and I do not beleive that these are anything but seizures)I don't think they know so they are calling them pseudoseizures. When these things happen I have dificulty walking, my perspective is out, things look bigger than they are, and the walls look like they are breathing. I am going to see my PCP this week and see bout getting a second opinion, what else can I do??
Score: 0 (0 votes cast)
January 18, 2010 3:58 PM | Posted, in reply to , by : | Reply
Steve,
You have my sympathy. Our 14 year old son who has a hx of petit mal seizures though was seizure free for 2 years, began passing out in Oct. 09. We saw many Drs. and had many tests, cardiologist, tilt table test, MRi, Neurology, Eplileptologist and so on. These events began turning into falling and his body seizing. He was seen at ER 5x and finally hosp. for 4-5days with EEG and video monitoring. Numerous events while in Hosp. but no EEG activity to indicate a true epileptic seizure. Diagnosis of conversion disorder. He's missed 4-5 weeks of school. Did improve after release from hosp and being told not seizures. Referred to Psychiatrist and Psychologist for testing/ meds. On anti-depressant and anti-anxiety at Bed time. Has fallen down stairs 4 x but not hurt much. Very scary and frustrating. These new Drs. have been great. Our Psychiatrist is contacting Mayo as our son is still falling/seizing and we may go there. This has been the most difficult thing in my life, waiting for the "thud" and wondering if he's o.k. Prior to this he seemed to have it all, good friends, playing football and Lacrosse and now it's difficult to get him through a day of school. I hope you find help and answers. Keep looking. I'll write in again to update.
Score: 0 (0 votes cast)
June 7, 2010 2:28 AM | Posted by : | Reply
Hi, my daughtet starting haveing fainting spells in Nov. 09 and as weeks past it occured more often. After visits with 3 different cardiologists, tilt table tests, she was sent to a nuerologist. He did an EEG and it was positive, so he diagnosed it as seizures. She continued and after a few more fainting spells she starting shaking like seizures cause. In April she had 8 seizures one day daily, transfferd to Tx childrens hosp. she was diagnosed with pseudoseizures, and was taken off the seizure meds.
she was sent to group therapy and there was diagnosed with bipolar disorder, adding to her depression diagnose from the hospital. She is now still going to theraoy, but continues to seize. What upsets me is that at times when she does not get her way, she has probably learned how to stress herself purposely to provoke a seizure. She will text her cousin or friend when she starts to feel sick but wont call me. It is going to be very difficult if she does not cocoperate with her care, I am also after her to take her meds. I am trying to get her to see a seizure specialist at tx childrens, lets keep posting our finding and hopefully someone will good answers to all these problems.
Score: 0 (0 votes cast)
Comments