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Psychogenic non-epileptic seizures (PNES), also referred to as pseudoseizures, non-epileptic attack disorder (NEAD), functional seizures, or dissociative seizures, [2] [3] are episodes resembling an epileptic seizure but without the characteristic electrical discharges associated with epilepsy. [4] [3] [5]
Physiological causes include fainting, sleep disorders, and heart arrhythmias. [2] [3] Psychological causes are known as psychogenic non-epileptic seizures. [3] Diagnosis may be based on the history of the event and physical examination with support from heart testing and an EEG. [3]
Diagnosis of epilepsy can be difficult. A number of other conditions may present very similar signs and symptoms to seizures, including syncope, hyperventilation, migraines, narcolepsy, panic attacks and psychogenic non-epileptic seizures (PNES). [133] [134] In particular, syncope can be accompanied by a short episode of convulsions. [135]
People also often have a family history of epilepsy and seem to have a genetically predisposed risk of seizures. IGE tends to manifest itself between early childhood and adolescence although it can be eventually diagnosed later. The genetic cause of some IGE types is known, though inheritance does not always follow a simple monogenic mechanism.
Because epileptic seizures typically include convulsions, the term convulsion is often used as a synonym for seizure. [1] However, not all epileptic seizures result in convulsions, and not all convulsions are caused by epileptic seizures. [1] [2] Non-epileptic convulsions have no relation with epilepsy, and are caused by non-epileptic seizures. [1]
Otherwise, the lack of typical postictal symptoms, such as confusion and lethargy following convulsive seizures, may be a sign of non-epileptic seizures. Usually such seizures are instead related to syncope or have a psychogenic origin ("pseudoseizures"). [3] The postictal state can also be useful for determining the focus of the seizure.
One retrospective observational study evaluated 328 selected patients from ages 16 to 57 years who had prolonged video-electroencephalogram (EEG) monitoring for medically intractable epilepsy and focal seizure onset; those with nonepileptic seizures, status epilepticus, and Lennox-Gastaut syndrome were excluded.
The goal is to record 3-4 typical seizures, though in some cases more or fewer seizures may need to be recorded. After this evaluation, some patients may be determined to have non-epileptic causes of their symptoms, e.g., syncope, psychogenic nonepileptic seizures, cardiac arrhythmia, etc.