Psychogenic Seizures

Introduction

Psychogenic seizures or pseudo seizures are non-epileptic seizures, which mimic epilepsy but actually have an underlying psychological cause.
In patients with this form of disorder, there may be a history of physical, sexual or psychological abuse.
The symptoms may be precipitated by stress and the signs are often variable and may include resistance to eye opening upon examination.

The diagnosis requires a high level of suspicion since it is often difficult to separate from epileptic seizures and may, in fact co-exist with epilepsy.

Symptoms of psychogenic seizures

The following are the symptoms of psychogenic seizures

  1. Recurrent tonic clonic-like seizures
  2. Attacks usually occur only when attention of other people can be attracted
  3. Patients hardly ever get injured, even when they fall (unlike in true seizures)
  4. Thrusting pelvic movements are common during “seizure” attacks
  5. Tongue biting, if it occurs is usually at the tip of the tongue instead of the sides as in true seizures
  6. May have urinary incontinence as in normal seizures

Investigations

  • Serum prolactin
  • EEG

Treatment for psychogenic seizures

Objectives

  1. To stop seizures
  2. To restore normalcy

Non-pharmacological treatment

  1. Reassure parents, guardians etc.
  2. Counselling
  3. Psychotherapy

Pharmacological treatment

  • Anti-epileptic medicines do not appear to have any beneficial effect on frequency of attacks

Referral Criteria

Refer all cases for evaluation by psychologist or psychiatrist.