Stress Overload: Nonepileptic Seizures
No one should ever underestimate the effects and power of stress. We all deal with stress differently. Some unwind with a glass of wine and feel better for it—whilst others bite their nails and sleep poorly. Some people think they are handling stress fine, but stress is a funny old thing in that a stress-related disorder can appear suddenly, as if out of nowhere. Some are genuinely shocked when that first panicky feeling arises or indeed a full-blown panic attack. For others, they know deep down that this has been coming for a long time because they are fully aware they have been stressed to the hilt and are simply not dealing with it.
Imagine your brain is a circuit full of fuses. Imagine that each relies on the next to keep a circuit of balance and mental equilibrium. Now imagine that each worry for every day, week or year is zapping the energy from this circuit. This is ok if we give it a rest now and again because it has chance to recharge. If we handle that stressful situation adequately all will remain well but if too much stress and worry is piled into the circuit we reach burn out or overload and a fuse blows. When that fuse blows, the result can be a psychological disorder.
This is just my way of looking at stress overload and its consequences. A trauma long past, producing post traumatic stress disorder (PTSD) or other anxiety disorders such as panic disorder may make us particularly susceptible to nonepileptic seizures also. We can all take so much but there is a limit to what we can handle before we lay ourselves open to disorders. One of those stress related disorders is named a conversion disorder.
What is Conversion Disorder?
Simply put, a conversion disorder develops when psychological stress that has not been addressed or resolved, has built to such an extreme point, that it shows itself in a physical form. Because the symptoms of conversion disorder are brought about by emotional conflict they are said to be of psychogenic, psychological or psychosomatic origin. Unfortunately this can be interpreted as being ‘all in your head’ but whilst no medical origin can be found, the symptoms are far from being made up. In fact someone who discovers that they have a conversion disorder can feel just as confused as the doctors! You will feel you simply can not control the physical symptoms.
Symptoms of Conversion Disorder
- A conversion disorder can show itself in various physical ways such as:
- Paralysis usually in an arm or leg
- Blindness or severe visual disturbance
- Difficulty in swallowing (globus hystericus)
- Difficulty in speaking
- Difficulty in walking
- Difficulty with coordination and balance
In this article I want to look at the conversion disorder that causes someone to have nonepileptic seizures.
What are Nonepileptic Seizures?
Nonepileptic seizures are also commonly called pseudoseizures, psychogenic seizures, dissociative seizures, or nonepileptic attacks. They appear in varying degrees from trances that look like spells of staring to strong jerking movements that look like full tonic-clonic seizures (grand mal). If it wasn’t for the fact that you are conscious during a limb thrashing or jerking nonepileptic attack, people would automatically assume you were having a tonic-clonic seizure. That said, if eyes are closed during a nonepileptic seizure, people may assume you have become unconscious. Becoming semiconscious or blacking out can be a complication of a nonepileptic seizure, though it is the exception to the rule.
Just as with any epileptic seizure, a nonepileptic sufferer may fall to the ground and exhibit repetitive jerking of the limbs, usually all four limbs. Rigidity and severe shaking are common. It has been known for the person to urinate during an attack and bite their tongue, though this happens far less than in other forms of epilepsy.
Nonepileptic seizures can cause physical harm such as bruising just as with other epilepsy because the limb jerks can not be controlled by the sufferer. Epileptics tend to have auras before a seizure, and nonepileptic seizure sufferers also tend to get a warning of some nature slightly before a seizure begins. It might just be a strong uneasy feeling in the tummy, a strange headache, dizziness, or a feeling of losing awareness or concentration.
Some Differences Between Epileptic and Nonepileptic Seizures
Abnormal electrical discharge
No abnormal electrical discharge
Of physical origin
Of psychological origin
Need for antiepileptic drugs
No need for antiepileptic drugs
Abnormal EEG reading
Normal EEG reading
Can occur in sleep
Do not occur in sleep
Tend to happen very suddenly
Can happen gradually
True synchronization of limb jerks
Sometimes changing limb jerks
Tendancy to urinate during seizure
Less likely to urinate
Biting the tongue happens frequently
Less likely to bite tongue
Loss of consciousness not unusual
Unconsciousness quite unusual
Diagnosis is tricky for doctors and psychiatrists. It isn’t unusual to be sent backwards and forwards between medical doctors and psychiatrists for some time before a diagnosis is made. Misdiagnosis is not uncommon when nonepileptic seizures begin. Your general doctor will initially order tests such as blood tests, and he will naturally presume if he sees one of your seizures that the cause is neurological. A referral to a neurologist is quite usual when these initial tests have yielded no positive results. This is the best route to a firm diagnosis as a neurologist will order specific testing before deciding on epilepsy or nonepilepsy. After examining your history of symptoms, tests that can confirm nonepileptic seizures are:
- Electroencephalogram (EEG) – to measure electrical activity in the brain. The downside to this test is that people without seizures can sometimes, if rarely, show abnormalities.
- Video Telemetry – having an EEG with video recorder monitoring over a longer period of time, usually a couple of days. The downside to this test is that of course you must have a nonepileptic seizure during the recording for accurate diagnosis.
How to Cope
From your first seizure to a firm diagnosis, you will probably go through a very confusing and worrying time. You will presume you have a medical illness because medical doctors are involved. When a psychiatrist insists there is a physical problem and a medical doctor insists it is a psychological problem, you are often left feeling as though your seizures don’t belong in any category! This is frightening because all you want is for your seizures to stop. You know you can’t stop them but it seems nobody else knows how to stop them either.
I will give you a word of advice to aid the process of diagnosis. Antiepileptic drugs will not stop nonepileptic seizures, and although you shouldn’t be on these drugs unless necessary, taking them for a brief time will tell you and the doctors that medical epileptic causes are unlikely if your seizures continue. I could also say that to try a small amount of a benzodiazepine (5-10mg), such as valium, directly on the tongue, at the onset of a seizure, should calm it down within 20-30 minutes. This will also point to a more likely scenario of nonepileptic seizures.
When you have had it confirmed that your seizures are of a psychological origin, you may feel many emotions. Shame and embarrassment are usual feelings on diagnosis but you must remember, you are not a malingerer and you are not making these symptoms happen consciously. You can not stop these seizures occurring and if you try hard to stop a seizure whilst it’s happening, such focus may even make the symptoms feel worse!
Nonepileptic seizures are frightening to the sufferer. You can feel distant whilst a seizure is taking place. You may not hear what people are saying or be able to observe your surroundings in clear focus. Your ability to speak during a seizure may be severely impaired. When it is over you may feel exhausted and feel physical pain from the severity of the limb jerks. Headache is common after a seizure, ironically much the same as with any seizure. You will often feel the onset of a seizure a minute or two before it takes on full strength and you can at least make sure you are in a safe place, preferably on the floor with nothing around you that may hurt you physically. Try to lie on your side if at all possible (as in the recovery position), with something protective under your head such as a pillow or cushion.
You should explain to those who live with you what you would like them to do whilst you are having a seizure. Just having someone with you is comforting but if they understand your seizures they can help you stay safe.
Nonepileptic seizures are difficult to treat, and a patient may have to wait some time before any psychological therapy can be arranged. A therapist may be able to help in coming to terms with the diagnosis, working out what caused you to start having the seizures, addressing the causes and learning how to cope with the actual seizures.
Self-Help for Nonepileptic Seizures
- Learn how to relax sufficiently
- Take up yoga or meditation
- Make a list of triggers and address the triggers
- Don’t be tempted to avoid situations and try and carry on as normal or you will develop other anxiety disorders
- Buy a medical alert wristband so that if the seizures happen amongst strangers, at least they will know you have such a condition
Remember, nonepileptic seizures can resolve completely, so don’t lose hope. Equally, remember how they arrived and do what you can to resolve the way you handle stress in your life.