Although Some Seizures Are Psychological, Doctors Should Not Use This Diagnosis Lightly

Up to 30 percent of those diagnosed with epilepsy don't actually have the disorder. They have psychological nonepileptic seizures, or psychogenic seizures, that are caused by psychological conditions, not by the abnormal electrical activity in the brain that causes epileptic seizures. These seizures do not respond to anti-convulsant medication.

(For some perspective on this research, see the Editor's Note at the bottom of the page.)

The researchers did three studies that provided clues as to which seizures were epileptic and which were not.

1. Researchers reviewed videos of 208 people whose seizures were monitored at Barrow Neurological Institute in Phoenix, AZ. They found that 50 out of 52 people with psychological nonepileptic seizures closed their eyes during seizures, while 152 out of 156 people with epileptic seizures opened their eyes during seizures.
2. The second study compared 26 people whose psychological nonepileptic seizures began when they were 55 or older to 241 people whose nonepileptic seizures started when they were younger than 55. The researchers found that those with late onset nonepileptic seizures were more likely to be male (42 percent compared to 23 percent) and have severe health problems (42 percent and eight percent). The late onset group was more likely to report health-related traumatic experiences (47 percent compared to four percent) and less likely to report a history of sexual abuse (four percent and 32 percent).
3. The third study examined 18 people seen in the emergency room for continuous seizures, or status epilepticus, that did not respond to epilepsy medication. Compared to those with epileptic seizures, those with nonepileptic seizures were more likely to be less than 30 years old, were more likely to have a port system implanted for administration of IV drugs and had lower blood levels of the enzyme creatine kinase, which normally rise after epileptic seizures.

[Editor's Note: This research can be misleading. A psychological diagnosis may be used when a physician cannot find another diagnosis for a particular condition. A good example is Multiple Chemical Sensitivity (MCS). Some people with MCS have seizures when exposed to pesticides or other chemicals. Doctors who do not believe MCS exists may refer patients to a psychiatrist instead of offering much needed help or referral to a specialist in environmental medicine. However, no practitioner worth his/her salt will dismiss seizure-like activity as psychologically determined without proper testing. Even if an environmentally-triggered seizure does not respond to anti-convulsant medication, that does not mean the seizure is psychological in origin.]