Can POTS Cause Non-Epileptic Seizures? The Controversial Link

Can POTS Cause Non-Epileptic Seizures?

Postural orthostatic tachycardia syndrome (POTS) is a disorder that affects blood flow and blood pressure control. Since POTS impacts the autonomic nervous system, some people with POTS experience episodes that resemble seizures, but are not caused by abnormal electrical brain activity like epilepsy. These non-epileptic seizure-like events are controversially linked to POTS and dysautonomia.

What is POTS?

POTS is a form of dysautonomia - an abnormality of the autonomic nervous system. This system controls unconscious body functions like heart rate, blood pressure, breathing, digestion, and more.

In POTS, the autonomic nervous system struggles to regulate blood pressure in response to postural changes. When moving from lying down to standing up, blood is supposed to pump up to the brain against gravity. POTS patients experience reduced blood return to the heart, leading symptoms like:

• Rapid heart rate increase of 30+ beats per minute when standing
• Lightheadedness, dizziness, or fainting upon standing
• Fatigue
• Exercise intolerance
• Headache
• Brain fog, concentration problems
• Nausea
• Chest pain
• Heart palpitations

These symptoms are relieved by lying back down and worsen with prolonged upright posture. POTS predominately affects women between the ages of 15 and 50.

What Are Non-Epileptic Seizures?

Non-epileptic seizures, also called psychogenic non-epileptic seizures (PNES), look like epileptic seizures but do not show abnormal electrical brain activity on an EEG. Other names for these seizure-like episodes include dissociative seizures and pseudo-seizures.

Instead of originating in the brain, non-epileptic seizures have a psychological trigger. However, the person experiencing a PNES event does not have voluntary control over the episode. The seizure-like movements and experiences are involuntary.

PNES episodes can involve convulsions, stiffening or jerking movements, staring spells, unresponsiveness, twitching, and more. These outward signs resemble various types of epileptic seizures. But with PNES, the brain EEG remains normal.

Can POTS Cause Seizure-like Events?

Some people with POTS do experience episodes that resemble seizures, but a clear link between POTS and seizure activity is still under debate. Here are some key considerations:

• Fainting or collapsing from blood pressure and blood flow irregularities may be mistaken for seizures.
• Severe drops in blood pressure in the brain lead to hypoxia and temporary impaired brain function.
• Autonomic dysfunction impacts nerve signaling that coordinates movement, potentially causing seizure mimics.
• Anxiety and PTSD are more common in POTS patients and increase PNES risk.
• Headache, brain fog, tremors, and numbness from POTS may be mistaken for focal seizures.

Researchers have aimed to quantify the overlap between POTS and seizure-like activity. Small studies have found around 10-20% of POTS patients experience non-epileptic seizures. However, it remains unclear whether POTS directly causes the seizures.

Assessing POTS and Seizures

Since the link between POTS and seizure-like activity is controversial, thorough evaluation is needed. Important steps include:

• EEG monitoring during an episode to check for epileptic seizure brain activity
• EKG and vitals during an episode to assess heart rhythm and blood pressure changes
• Evaluating for other causes like epilepsy, cardiac syncope, or hypoglycemia
• Autonomic nervous system testing like QSART, tilt table test
• Considering trauma history or mental health factors that may contribute to PNES

POTS and epilepsy can occur together in the same person as well. Some patients have seizures that show up on EEG plus additional non-epileptic seizure-like episodes related to their POTS and dysautonomia.

Managing POTS Episodes Resembling Seizures

Whether caused directly by POTS or not, episodes that resemble seizures can be frightening and dangerous. Following precautions can help reduce risk of injury during a collapse or convulsive event:

• Avoid driving or operating machinery alone if episodes occur regularly.
• Shower or bathe while seated if episodes occur in the bathroom.
• Wear a helmet for protection during episodes involving convulsions.
• Use walls, rails, and assistance devices if your balance is poor.
• Carry identification noting your seizure disorder and medical conditions.
• Consider wearing a medical alert bracelet or pendant.

Making adjustments to POTS treatment may also minimize episodes in some patients:

• Increase fluid and salt intake to improve blood volume.
• Try compression garments to help blood return to the heart.
• Raise the head of your bed and sleep with legs elevated.
• Take breaks between activities and sit or lie down as needed.
• Consider medication changes if low blood pressure contributes.
• Seek counseling for anxiety, PTSD, or other mental health issues.

Ongoing collaboration between your cardiologist and neurologist is key to sorting out the cause and finding optimal treatment.

Causes and Risk Factors for Non-Epileptic Seizures

Since non-epileptic seizures do not arise from abnormal electrical brain activity, what does trigger these involuntary physical events? Understanding the potential causes can help guide evaluation and treatment.

Psychological Causes

For many patients, non-epileptic seizures have an underlying psychological trigger. Emotional trauma, overwhelming stress, unresolved psychiatric disorders, and difficulty coping are frequently associated with PNES.

PTSD doubles the risk of developing non-epileptic seizures. History of abuse or trauma is also very common in PNES patients. Difficult early life events seem to create a vulnerability to experiencing seizure-like dissociative episodes.

Other psychological conditions like depression, anxiety disorders, eating disorders, and personality disorders occur more often in those with PNES as well. These factors are believed to lower the seizure threshold.

Neurological Causes

While not electrical abnormalities in the brain like epilepsy, issues with the central nervous system may play a role in non-epileptic seizures in some patients. Neurological conditions associated with increased PNES risk include:

• Traumatic brain injury
• Stroke
• Brain tumor
• Alzheimer's disease
• Parkinson's disease
• Multiple sclerosis

Structural changes in the brain, neurodegeneration, inflammation, and nerve damage influence excitability that could potentially trigger seizure mimics.

Medical Causes

A number of other medical problems are linked to increased incidence of non-epileptic seizures, including:

• Chronic pain syndromes like fibromyalgia
• Migraines
• Sleep disorders
• Autoimmune diseases
• POTS and dysautonomia
• Cardiac syncope
• Metabolic disorders

Some seizure-like episodes may represent a physical manifestation of symptoms from these conditions. However, in most cases a clear physiological cause is not identified.

Pseudoseizures

Rarely, non-epileptic seizure-like behaviors are fabricated and do not represent an involuntary event. Pseudoseizures

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.