Understanding Causes and Treatments for Non-Epileptic Seizures

Understanding Non-Epileptic Seizures

Seizures are alarming events that can happen even without epilepsy. Known as non-epileptic seizures, these episodes resemble epileptic seizures but stem from other causes. Getting the right diagnosis is key to effective treatment and prevention.

While epilepsy affects only about 1% of people, around 10% will experience a non-epileptic seizure in their lifetime. Understanding what causes these seizure-like episodes and how they differ from epileptic seizures can provide answers and relief.

Common Causes of Non-Epileptic Seizures

Non-epileptic seizures have physical, psychological, and situational triggers including:

• Syncope: Also called fainting or passing out, syncope can cause brief seizure-like activity upon falling due to reduced blood flow to the brain.
• Hypoglycemia: Low blood sugar, often occurring in diabetes, provokes seizure-like shaking and confusion that is relieved by raising glucose levels.
• Migraines: About 3-5% of migraine attacks manifest with vision loss, numbness, and seizure-mimicking symptoms known as migraine aura.
• Panic attacks: During severe anxiety or panic attacks, people may experience shaking, paralysis, or loss of consciousness resembling a psychogenic non-epileptic seizure.
• Sleep disorders: Disruptions during sleep phases can generate seizure-like movements and behaviors arising from deep sleep.
• POTS: Postural orthostatic tachycardia syndrome (POTS) can cause rapid heartbeat, fainting, and seizure-like tremors upon standing.

When to Suspect Non-Epileptic Seizures

Non-epileptic seizures may be mistaken for epilepsy at first. Clues that point to a non-epileptic cause include:

• Absence of typical epileptic EEG changes during the seizure-like event
• No response to standard epilepsy medications
• A normal MRI scan of the brain
• Situational triggers like stress or standing up suddenly
• Unusual movements like side-to-side head shaking
• Gradual onset and cessation of the episode
• Amnesia for the entire event afterwards

Getting Properly Diagnosed

Distinguishing non-epileptic and epileptic seizures requires specialty testing like:

• EEG monitoring: Recording brain wave activity before, during and after a seizure can help classify epileptic versus non-epileptic events.
• Tilt table testing: Monitoring heart rate and blood pressure changes in response to shifting body position can help reveal syncopal or POTS-related non-epileptic seizures.
• Blood tests: Checking glucose, electrolytes and other lab work helps detect metabolic causes of seizure-like episodes.
• Psychological evaluation: A mental health assessment can identify contributing psychological factors behind non-epileptic seizures.

Often a combination of clinical information and testing is required to reach the correct diagnosis. Seeing an epilepsy specialist (epileptologist) or neurologist can ensure appropriate workup and interpretation of results.

Non-Epileptic Seizure Treatment Options

Effective treatment of non-epileptic seizures centers on managing the underlying trigger, which may include:

• Medication adjustment: Altering the dose or type of medication being taken under medical supervision.
• Psychotherapy: Counseling and cognitive behavioral therapy to help cope with stressors or past trauma that provoke symptoms.
• Dietary changes: Regulating meals, snacks and beverage intake to stabilize blood sugar and electrolyte levels.
• Compression garments: Wearing compression stockings or abdominal binders can improve blood flow deficits in conditions like POTS.
• Relaxation techniques: Biofeedback, meditation, guided imagery, and progressive muscle relaxation help control anxiety-related episodes.

Standard epilepsy drugs are typically not effective for non-epileptic seizures. But other medications like SSRIs or propranolol may help in certain cases under medical guidance.

Using a Seizure Diary

Keeping a detailed seizure diary is invaluable for identifying patterns and potential triggers for proper diagnosis and management. Helpful information to record includes:

• Date, time, and length of the seizure-like episode
• Situation and location of where it occurred
• Activities preceding the event
• Symptoms experienced and areas of body involved
• Level of awareness and memory of the event
• Coordination problems, confusion or fatigue afterwards
• Any injuries sustained

Comparing diary entries over time reveals important clues for discussion with your doctor and determining appropriate testing.

Preventing Future Non-Epileptic Seizure Episodes

While non-epileptic seizures cannot always be fully prevented, the following strategies can reduce frequency and severity:

• Take medications consistently as prescribed.
• Adopt regular mealtimes and snack breaks to maintain steady glucose levels.
• Stay well hydrated and minimize alcohol intake.
• Apply self-calming skills during stressful situations.
• Practice good sleep hygiene for restful sleep.
• Increase salt and fluid intake before warm weather activity.
• Avoid triggers like flashing lights, unfamiliar places, overtiredness.
• Carry medical ID noting seizure disorder.

Ongoing communication with your medical team ensures emerging symptoms or side effects get promptly addressed.

Knowing What to Do During an Episode

When a non-epileptic seizure episode occurs, these tips can help:

• Time the event and note all symptoms displayed.
• Loosen any tight clothing and protect the person from injury.
• Do not restrain or put anything in the mouth.
• Speak calmly and reassure the person during and after the seizure.
• Turn them on their side if vomiting occurs.
• Call emergency services for seizures lasting over 5 minutes or for repeated seizures.

Proper first aid training prepares caregivers and family members to respond appropriately until the seizure resolves.

Outlook for Non-Epileptic Seizures

Non-epileptic seizures can be alarming and disruptive. But gaining an accurate diagnosis through specialty testing enables effective, targeted treatment to reduce occurrence and associated risks.

Being aware of the many potential causes behind non-epileptic seizure events, from syncope and sleep disturbances to POTS and migraines, is crucial. This allows for prompt recognition and application of appropriate management techniques.

While frustrating, psychological factors and stressors may also underlie non-epileptic seizures for some. Seeking counseling and practicing relaxation skills can help gain control. Overall, working closely with your medical team provides the greatest chance of minimizing further episodes.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.