Dissociative seizures are similar to epileptic seizures as they cause involuntary movements and behaviors. However, unlike epileptic seizures, dissociative seizures can occur without corresponding seizure activity in the brain.

Dissociative seizures can look similar to epileptic seizures, which means that some people may not initially recieve the correct diagnosis. This can be harmful, as the treatments and medications for epilepsy will not stop dissociative seizures.

The treatments for dissociative seizures can involve therapy, managing underlying medical illness, treatment of sleep disorders, anti-anxiety medication, or a combination of these and other interventions. With treatment, dissociative seizures can significantly improve or go away entirely.

This article discusses the symptoms, causes, diagnosis, and treatment of dissociative seizures. It also offers tips for dealing with the condition.

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Dissociative seizures are a type of nonepileptic seizure resulting from non-epileptic factors. They cause episodes of involuntary movements or behaviors. In the United States, doctors refer to these seizures as psychogenic nonepileptic seizures (PNES).

During a PNES episode, a person may be dissociated, which means that they are not fully aware or in control of themself. They may fall in and out of consciousness or become unresponsive for brief periods.

PNES can look very similar to epileptic seizures. However, epileptic seizures are caused by altered electrical activity in the brain, but PNES is not caused by altered electrical activity in the brain. This difference is one of the main ways in which doctors tell the two types apart.

You need medical care to identify the cause and have a treatment plan if you have dissociative seizures, and you would need emergency treatment for a dissociative seizure if it caused you to become injured.

It is unclear how common PNES is, but among people who require monitoring in a hospital for treatment resistant seizures, 20–40% receive this diagnosis.

Other names for PNES include psychogenic nonepileptic episodes or pseudoseizures. However, many people feel that the term “pseudoseizure,” which is older, is unacceptable because it implies that the symptoms are not real, which creates stigma.

The symptoms of PNES can vary, but they often include:

  • changing levels of consciousness
  • shaking or thrashing movements
  • pelvic thrusting
  • side-to-side head shaking
  • brief episodes of unresponsiveness
  • yelling, crying, or other vocalizations
  • tightly closed eyes or mouth

Yes, it is possible for the two types of seizures to coexist. A 2022 review states that about 44% of people with PNES also have epilepsy. This co-occurrence can make diagnosing PNES more challenging.

However, there are some key differences between epileptic and nonepileptic seizures. For example, the eyes are closed during about 95% of dissociative seizures, whereas they are open during most epileptic seizures.

Similarly, being able to speak or yell during a seizure can be a sign of PNES, as can jumping at the sound of a loud noise — neither of which is common during an epileptic seizure.

There are many causes, risk factors, and triggers for PNES, including severe emotional distress. The symptom is strongly associated with mental health conditions, such as anxiety and depression, as well as past trauma.

Psychological trauma refers to the effects that severely stressful events have on the mind. These events can include a single event, such as a car accident, or multiple events that take place over an extended period.

A history of physical or sexual abuse is one of the risk factors for PNES.

Some of the conditions that have an association with PNES include:

Mental health is complex, and not everyone can identify a specific cause of their PNES. Even if that is the case, though, the episodes are real.

Doctors can sometimes diagnose PNES based on how the symptoms differ from those of epileptic seizures. They may be able to do this through observation or by speaking with the individual or the family members or friends who have witnessed the seizures.

The next step is to rule out epileptic seizures by measuring electrical activity in the brain. Doctors can do this via video electroencephalography (EEG) monitoring. During this test, an EEG monitor tests the electrical signals in the brain, while a camera records a seizure. The results allow a neurologist to make a diagnosis.

To do a video EEG test, a person may need to stay in a monitoring unit or another healthcare facility.

A major component of treatment for PNES is psychotherapy. By speaking with a psychologist or therapist, people can begin to understand the underlying cause of the seizures.

There are many types of therapy. The most well-studied type in the treatment of PNES is cognitive behavioral therapy (CBT). CBT works by looking at the relationships between beliefs and thoughts, emotions, and behaviors.

People with a history of traumatic experiences may benefit from trauma therapies, which include a range of techniques that encourage the brain to process distressing memories, reducing their impact.

Medications may help reduce the symptoms of underlying medical or mental health conditions and improve quality of life.

PNES can be disruptive, scary, or disorienting. While a person is undergoing treatment, though, there are ways to minimize these effects. The United Kingdom’s National Health Service (NHS) recommends the following coping strategies:

Sensory grounding

If a person gets any warning signs before a seizure, they can engage in sensory grounding. This involves the steps below:

  1. Find a rough or textured object to carry around. When a seizure is coming on, rub the object between the fingers, focusing on how it feels.
  2. Place the feet firmly on the ground and notice how solid it is.
  3. Find something to look at nearby, and describe what it looks like, either out loud or silently to oneself.
  4. Listen to the sounds coming from nearby, such as birds singing or people talking.

This strategy can prevent seizures or delay them long enough that a person can go somewhere private and safe.

Abdominal breathing

Abdominal breathing can promote calmness and prevent a seizure. A person can follow these steps:

  1. Sit with one hand on the belly, below the navel.
  2. Slowly inhale through the nose and feel the belly expand.
  3. Pause for 3 seconds, then slowly exhale through the nose.
  4. Repeat for 20 breaths or until the warning signs of the seizure have passed.

Seizure first aid

People can accidentally injure themselves during one. Seizure first aid includes practices that prevent this from happening.

It is helpful to let friends, family, or coworkers know what to do if a seizure occurs. They can help by:

  • removing any potentially dangerous objects from the area
  • guiding the person having the seizure to a safe place
  • putting something soft underneath their head
  • speaking to them calmly and reassuringly
  • not trying to restrict their movements or any noise they make, as this can be frightening and potentially lead to injuries

If someone does not experience any warning signs before a seizure, they should not drive because a seizure could occur unexpectedly, causing a risk of an accident.

Nonepileptic seizures rarely require emergency services. If someone does become injured, it is important to call 911 and say that the seizure was nonepileptic.

Identifying triggers

Some events or emotional states may trigger PNES. Identifying what these are can help someone understand how to reduce their seizures. It may help to keep a diary to record when they happen and any factors that might have contributed.

A person should try to maintain a normal routine and independence wherever possible but ask for help if the symptoms of PNES are causing physical or emotional difficulty.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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Dissociative seizures are a type of nonepileptic seizure that many refer to as PNES. They cause episodes of involuntary movements and behaviors that occur without epileptic brain activity, and can be associated with psychological distress.

Dissociative seizures can be similar to epileptic seizures and they are sometimes initially misdiagnosed as epileptic seizure.

Treatment for PNES can reduce seizure frequency and lessen the impact of underlying mental health conditions on a person’s life. If someone believes that they may be experiencing PNES, they should undergo an evaluation from a neurologist to get the correct diagnosis.