Diagnosing Non-Epileptic Seizures

Your physician may suspect non-epileptic seizures when some of the following are present:

  • Continuing seizures while taking seizure medications.
  • Seizures involving erratic, non-repetitive movements. Epileptic seizures are stereotypical, meaning, that most seizures a patient has look very similar.
  • Longer spells. Epileptic seizures tend to be shorter, with most lasting less than a minute or two.
  • A history of significant traumatic experiences such as physical, emotional, or sexual abuse, loss of close friends or relatives at an early age, unhappy adoption or foster care, or being a witness to a tragic accident.
  • Unusual posturing, side-to-side shaking of the head, banging the head against the wall, crying, stuttering, and arching of the back. All of these are symptoms rarely seen in epileptic seizures.
  • Medical history which may indicate a coexisting, poorly defined condition, psychogenic in nature, such as chronic pain poorly responsive to medical care.

Non-epileptic seizures may resemble generalized convulsions (similar to tonic-clonic seizures) with falling and shaking. Less often they may look like absence seizures (petit mal seizures) or complex partial epileptic seizures, with temporary loss of attention or staring.

Video EEG monitoring is the gold standard for diagnosing non-epileptic seizures. For many patients, this requires admission to an epilepsy monitoring unit (EMU). During admission, the patient is monitored over a time period of several hours to several days, with simultaneous video and EEG recordings until typical spells occur. Also, during this time, the patient's antiepileptic medications are tapered and may be completely discontinued.

An epileptologist (a neurologist who specializes in epilepsy) in the EMU will analyze the video and EEG recordings to assist in making the diagnosis. However, this can only be done if typical spells occur frequently enough. Certain techniques can be used to trigger seizures during the monitoring process.

Other doctors told me I had epilepsy

It's easy to confuse epileptic and non-epileptic seizures. Many patients with non-epileptic seizures have been given the diagnosis of epilepsy, based upon the description of the seizures reported to doctors. About 80% of patients with non-epileptic seizures have been treated with antiepileptic drugs for several years before the correct diagnosis is made. Every epileptologist who has been in practice for some time has seen patients who appear to have epileptic seizures by history, only to find out on video EEG monitoring that the actual diagnosis is non-epileptic seizures. Similarly, an individual believed to have non-epileptic seizures by history , may actually be diagnosed with epilepsy once they have been observed in the epilepsy monitoring unit. The reason that a patient's diagnosis may change after video EEG monitoring include:

  • Initial diagnosis relied upon description by observers, who may not have noticed important details.
  • Few physicians have access to video EEG monitoring performed by a neurologist who specializes in epilepsy (epileptologist).
  • Most doctors and patients assume that repeated seizures must be due to epilepsy, particularly when patients and doctors rarely link psychological events that may have happened years ago to a patient with unusual spells happening now.
  • A patient may have both epileptic and non-epileptic seizures which can be a very challenging problem for both diagnosis and treatment.
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