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Diagnosing Seizures Is Key to Treatment

According to the Centers for Disease Control and Prevention (CDC), about 1 out of 10 people will have a seizure during their lifetime. Most of these seizures will be epileptic seizures, which are caused by unusual brain activity that includes simultaneous firing of brain cells.

The other type of seizures are non-epileptic seizures or attacks (NES/A) that often resemble epileptic seizures but have a different cause. NES/A are usually brought on by underlying psychological distress or trauma. While the seizures might have similar symptoms, the treatment is quite different.

Epilepsy Diagnosis and Treatment

“Epilepsy is a diagnosis we give to patients who have a predisposition to having multiple unprovoked seizures,” says Brian Johnson, MD, an epileptologist in neurology at University of Utah Health. “When I say unprovoked, I mean seizures that are not caused by things like electrolyte abnormalities, blood sugar abnormalities, lack of sleep, or medications. It is really a statistical diagnosis based on your likelihood of having future epileptic seizures.”

For some patients, epilepsy begins in early childhood. According to Johnson, these children may have genetic or metabolic problems or have had perinatal strokes, which can occur during the last half of pregnancy or first month after birth. For other patients, epilepsy tends to be diagnosed in their 20s or later in life—in their 60s. By the time a patient is in their 60s, tumors, strokes or dementia can be factors in epilepsy.

Epileptic seizures have many forms, too. If it is a focal or partial seizure, the symptoms depend on which part of the brain is involved. “For example, if it is the part of the brain that involves vision, the patient may see flashing lights,” Johnson explains. “If it is the part of the brain that controls hand movement, then the patient may have hand twitching.”

Generalized seizures involve both sides of the brain. The individual will lose consciousness; there may be loss of muscle tone, and the patient may fall or have convulsions.

Non-Epileptic Seizures or Attacks (NES/A)

Non-epileptic seizures or attacks are also known as psychogenic non-epileptic seizures (PNES) and are believed to stem from underlying psychological distress, trauma, or another mental health condition.

Johnson says that about 20-30% of the patients that come to the Epilepsy Clinic at University of Utah Health for seizure evaluation have non-epileptic seizures. He explains the patients have usually experienced some sort of psychological trauma that has not been adequately addressed.

Because of the difficulty diagnosing the NES/A, the comprehensive assessment may include an electroencephalogram (EEG) to determine whether abnormal brain activity accompanied epileptic seizures.

Assessment of PNES also includes identifying psychiatric disorders that the patient may have. According to the Epilepsy Foundation, NES/A can be caused by the following disorders:

  • A history of mood disorders
  • Anxiety
  • Post-traumatic stress disorders
  • History of physical, emotional, or sexual abuse
  • Family stressors or conflict
  • Psychosis
  • Personality disorders
  • Attention problems
  • History of traumatic brain injury
  • Substance abuse

Symptoms of NES/A vary. “Sometimes, the symptoms are manifestations of trauma a patient has experienced,” Johnson says. “It might involve flailing, moving the head back and forth, or periods of unresponsiveness. Oftentimes, the patient will describe this feeling of paralysis. They can hear and see things around them, but they can't move their body and they can't respond to anything that's outside of their body.”

If You or Someone You Know Has a Seizure

  • Make sure the person is safe and doesn’t put anything in their mouth.
  • Record how long the seizure lasts.
  • Stay calm.
  • After the seizure is over, put the person on their side.
  • Write down everything that happened.

If you have had a seizure or suspect you had a seizure, the Epilepsy Foundation advises to recall everything that happened leading up to the event and get details about what happened during the seizure from anyone else who was present. Your doctor may ask many questions, such as:

  • What were you doing that day? 
  • What medications did you take that day?
  • Were you sick recently?
  • What were you doing immediately before the seizure or suspected seizure? 
  • What time of day was it?
  • How did it begin? Did you have any warning beforehand?
  • Were you able to talk or respond appropriately?
  • Afterward, were you confused or tired, or could you speak normally?

Your doctor may also have questions about your medical history, such as if you have ever had a head injury or high fever as a child accompanied by a seizure.

Seizures Can Be Treated

The first line of treatment for epilepsy is medication. Johnson reports that about two-thirds of patients respond to anti-seizure medications. If patients don’t respond to the medication, then surgery may be a possibility. “If somebody is a good candidate for brain surgery, we can actually cure their epilepsy, which is something that we really can't do with seizure medicines,” Johnson says.

Conversely, NES/A does not respond to anti-seizure medications. The treatment of choice is often cognitive behavioral therapy, which can be used in conjunction with other treatments for the underlying psychological problem. Cognitive behavioral therapy helps patients learn skills to modify their thoughts and behaviors that lead to NES/A symptoms.

Most importantly, see your doctor right away. They will want to rule out medical conditions such as diabetes that might cause symptoms. You may be referred to a neurologist for further tests such as an EEG or other brain imaging. If epilepsy is ruled out, you may be referred to a psychiatrist or psychologist for NES/A.