Frontier: Identifying Different Seizures

by Rabiya S. Tuma

July, 2006

Approximately 5 percent of adults with seizures have psychological nonepileptic seizures, which seem outwardly to resemble epileptic seizures but lack a discernible organic cause. Physicians often have a hard time distinguishing these seizures from epilepsy because the seizures in the two disorders look similar, even though the biology of psychological nonepileptic seizures is quite unlike that of epilepsy. In a study published in the June 13 issue of Neurology, Steve Chung of the Barrow Neurological Institute in Phoenix reports that during a psychological seizure most patients close their eyes, whereas patients rarely close their eyes during an epileptic episode.

It takes about five years for a patient with psychological nonepileptic seizures to get an accurate diagnosis, says Chung. Many patients have to undergo seven days of observation in the hospital, with video and monitoring of their brain electrical patterns with an electroencephalogram. Unlike epileptic seizures, which are accompanied by dramatic changes in patterns of electrical discharge in the brain, no change in brain-wave activity occurs during a psychological seizure.

When Chung’s group reviewed videos of seizures in 52 patients diagnosed with psychological nonepileptic seizures, they found that 50 patients closed their eyes during an episode. By comparison, only four out of 156 patients with epilepsy did. The team is now working to test whether this characteristic can be used by family members to help diagnose psychological nonepileptic seizures in an outpatient setting.

Psychological nonepileptic seizures occur most often in individuals who experienced major psychological or physical trauma at some point during their life. And though anti-epileptic drugs do not help, antidepressants and behavioral modifications such as psychotherapy or meditation sometimes do. “There is some evidence that if you catch it early on and educate the patient, they do much better,” says Chung.