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Psychogenic seizures are non-epileptic paroxysmal movements that constitute a psychopathological challenge in clinical practice. If you want to know more about these crises, keep reading!
Epileptic seizures are transient paroxysmal alterations that occur unexpectedly and abruptly caused by abnormal neuronal activity. These seizures can be categorized as epileptic and non-epileptic. Within the latter is where psychogenic seizures appear, known medically as psychogenic non-epileptic seizures (PNES).
The prevalence of these seizures varies from 17% to 60%, and they can coexist with epileptic seizures. In fact, research found that the prevalence of psychogenic seizures is 3.6% to 10.8% in patients with epilepsy, and that epileptic seizures, in turn, have a prevalence of 12% to 36% in people with seizures. psychogenic.
Psychogenic crises
They are a set of sudden and immediate changes in behavior, cognition and sensory perception that simulate epileptic seizures, but without abnormal neuronal discharge. These crises are correlated to a psychological mechanism and not a biological one, which is why they are recognized as psychogenic.
The term psychogenic allows us to differentiate this type of seizure from those that are non-epileptic convulsive seizures generated by a transient ischemic attack, migraines, syncope, etc. In these cases, the cause of the seizure has a neurological basis that explains the appearance of the non-epileptic seizure.
Dissociative symptoms are the most common in people with psychogenic crises.
The main symptoms of PNES are the following:
Head movements from side to side.Increase and decrease in consciousness.Asynchronous movements of the extremities.Eyes closed.Dystonic postures.Pelvic forward movements.
Psychogenic seizures have been associated with a variety of psychiatric disorders, including (Giagante et al., 2007):
emotional problems: In PNES patients, comorbidities with depression and dysthymia have been found in between 40% and 80% of the patients studied.Anxiety disorders: post-traumatic stress disorder has been found quite frequently, between 35% and 49%, in patients with psychogenic crisis.Dissociative disorders: Dissociative symptoms are very common in PNES patients (90%).Somatoform problems: The symptoms of these disorders are associated with the dissociative and conversion symptoms of non-epileptic psychogenic seizures.Personality alterations: The most common disorders are borderline, dependent, histrionic and avoidant disorders.
Causes and associated factors
The etiology of these crises is very diverse, but it is believed that They arise as a maladaptive coping mechanism in the face of stress or anguish. The psychological conflict that arises from an intolerable existential situation translates into physical symptoms (seizures) that keep the stressors out of consciousness (Alsaadi and Marquez, 2005).
The factors that have been most associated with psychogenic crises are sexual and physical abuse, trauma, neurological abnormalities, family dysfunction, stressful life events, poor interpersonal skills, personality disorders, and avoidant coping. Abuse and neglect are considered predisposing factors that can increase vulnerability to the development of these crises.
Some precipitating factors that have been related to PNES are rape, death or separation from a loved one, loss of employment, accidents, surgical procedures, and natural disasters, among others.
Also Several perpetuating factors have been identified such as anger, anxiety, depression or abuse. These factors make it impossible for the patient to regain control of the situation and aggravate the problem of seizures.
Although the etiology of psychogenic crises is very diverse, it is thought to be a maladaptive mechanism for coping with stress or anxiety.
Treatment of psychogenic crises
The therapeutic approach and treatment will depend on the case, the precipitating, triggering and perpetuating factors of the patient.
To do this, there is a wide variety of interventions that can be used such as behavioral therapy, hypnosis, psychoeducation or family therapy (Bodde et al., 2009).
Cognitive behavioral therapy is an excellent treatment option. In research, it was found to be more effective than standard medical care in reducing seizure frequency in people with psychogenic non-epileptic seizures.
Other strategies that I know can be implemented in the intervention plan for PNES are lifestyle changes, antidepressant medication therapy, and interpersonal psychodynamic therapy.
These strategies not only seek to reduce the seizures typical of psychogenic crises, but also to improve the psychiatric comorbidities with which it is associated, recover functionality in daily life and improve the patient’s quality of life.
In conclusion, Psychogenic nonepileptic seizures include paroxysmal changes in behavior, consciousness, and body movements. that resemble epileptic seizures, but are not based on electrophysiological changes in the brain.
Its diagnosis and treatment is a challenge, since its cause is not precisely known, in addition to the fact that a wide variety of psychiatric and psychological problems can end up converging in it.
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All cited sources were reviewed in depth by our team to ensure their quality, reliability, validity and validity. The bibliography in this article was considered reliable and of academic or scientific accuracy.
Alsaadi, TM, & Marquez, AV (2005). Psychogenic nonepileptic seizures. American family physician, 72(5), 849-856.Bodde, NM, Brooks, JL, Baker, GA, Boon, PA, Hendriksen, JG, & Aldenkamp, AP (2009). Psychogenic non-epileptic seizures—diagnostic issues: a critical review. Clinical neurology and neurosurgery, 111(1), 1-9.Asadi-Pooya, AA (2017). Psychogenic nonepileptic seizures: a concise review. Neurological Sciences, 38(6), 935–940. doi:10.1007/s10072-017-2887-8.Jafari, A., Tavirani, M.R., Hamrah, M.P., Karvigh, S.A., & Fakhar, HBZ (2020). Psychogenic non-epileptic seizures; a narrative review. Archives of Academic Emergency Medicine, 8(1).Kuyk, J., Leijten, F., Meinardi, H., Spinhoven, PH, & Van Dyck, R. (1997). The diagnosis of psychogenic non-epileptic seizures: a review. Seizure, 6(4), 243-253.Giagante, B., D’Alessio, L., Silva, W., & Kochen, S. (2007). Psychogenic non-epileptic seizures. Colombian Journal of Psychiatry, 36, 187-207.Perea, E., Torres, M. and Suárez, M. (2012). Psychogenic crisis, a linking psychiatric pathology. About a case. Colombian Journal of Psychiatry, 41(3), 680-689.
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