Non-epileptic seizures (NES), also known as non-epileptic events, are

paroxysmal Paroxysmal attacks or paroxysms (from Greek παροξυσμός) are a sudden recurrence or intensification of symptoms, such as a spasm or seizure. These short, frequent symptoms can be observed in various clinical conditions. They are usually ...

events that appear similar to an

epileptic seizure An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with lo ...

but do not involve abnormal, rhythmic discharges of

neuron A neuron, neurone, or nerve cell is an electrically excitable cell that communicates with other cells via specialized connections called synapses. The neuron is the main component of nervous tissue in all animals except sponges and placozoa. ...

s in the brain. Symptoms may include shaking, loss of consciousness, and loss of bladder control. They may or may not be caused by either

physiological Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...

psychological Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries between t ...

conditions. Physiological causes include

fainting Syncope, commonly known as fainting, or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, typically from ...

sleep disorders A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tes ...

, and heart arrhythmias. Psychological causes are known as

psychogenic non-epileptic seizures Psychogenic non-epileptic seizures (PNES) are events resembling an epileptic seizure, but without the characteristic electrical discharges associated with epilepsy. PNES fall under the category of disorders known as functional neurological disor ...

. Diagnosis may be based on the history of the event and

physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patien ...

with support from heart testing and an

EEG Electroencephalography (EEG) is a method to record an electrogram of the spontaneous electrical activity of the brain. The biosignals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in the neocortex ...

Terminology

The

International League Against Epilepsy The International League Against Epilepsy was started in 1909. Its goal is to improve the lives of people with epilepsy Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic sei ...

(ILAE) define an

as "a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain." (Free full text online). Convulsive or non-convulsive seizures can occur in someone who does not have epilepsy – as a consequence of

head injury A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of inju ...

drug overdose A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended.

, toxins,

eclampsia Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia. Pre-eclampsia is one of the hypertensive disorders of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of protein in ...

or febrile convulsions. A provoked (or an un-provoked, or an idiopathic) seizure must generally occur twice before a person is diagnosed with epilepsy. When used on its own, the term ''seizure'' usually refers to an epileptic seizure. The lay use of this word can also include sudden attacks of illness, loss of control, spasm or stroke. Where the physician is uncertain as to the diagnosis, the medical term ''paroxysmal event'' and the lay terms ''spells'', ''funny turns'' or ''attacks'' may be used.

Signs and symptoms

*Convulsions *Crying out or making a noise *Stiffening *Jerky, rhythmic or twitching motions *Falling down *Loss of consciousness *Confusion after returning to consciousness *Loss of bladder control *Biting the tongue

Causes

Possible causes include: * Syncope (fainting) ** Reflex anoxic seizures *

Breath-holding spells Breath-holding spells (BHS) are the occurrence of episodic apnea in children, possibly associated with loss of consciousness, and changes in postural tone. Breath-holding spells occur in approximately 5% of the population with equal distribution b ...

of childhood *

Cataplexy Cataplexy is a sudden and transient episode of muscle weakness accompanied by full conscious awareness, typically triggered by emotions such as laughing, crying, or terror. Cataplexy affects approximately 70% of people who have narcolepsy, and i ...

Hyperekplexia Hyperekplexia (; "exaggerated surprise") is a very rare neurologic disorder classically characterised by pronounced startle responses to tactile or acoustic stimuli and hypertonia. The hypertonia may be predominantly truncal, attenuated during ...

, also called startle syndrome *

Migraine Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...

Narcolepsy Narcolepsy is a long-term neurological disorder that involves a decreased ability to regulate sleep–wake cycles. Symptoms often include periods of excessive daytime sleepiness and brief involuntary sleep episodes. About 70% of those affect ...

*Non-epileptic

myoclonus Myoclonus is a brief, involuntary, irregular (lacking rhythm) twitching of a muscle or a group of muscles, different from clonus, which is rhythmic or regular. Myoclonus (myo "muscle", clonic "jerk") describes a medical sign and, generally, is ...

Opsoclonus Opsoclonus refers to uncontrolled, irregular, and nonrhythmic eye movement. Opsoclonus consists of rapid, involuntary, multivectorial (horizontal and vertical), unpredictable, conjugate fast eye movements without inter- saccadic intervals. It is ...

Parasomnia Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Parasomnias are dissociate ...

s, including

night terrors Night terror, also called sleep terror, is a sleep disorder causing feelings of panic or dread and typically occurring during the first hours of stage 3–4 non-rapid eye movement (NREM) sleep and lasting for 1 to 10 minutes. It can last long ...

* Paroxysmal kinesigenic dyskinesia *Repetitive or

ritualistic A ritual is a sequence of activities involving gestures, words, actions, or objects, performed according to a set sequence. Rituals may be prescribed by the traditions of a community, including a religious community. Rituals are characterized, ...

behaviours *

Tic A tic is a sudden, repetitive, nonrhythmic motor movement or vocalization involving discrete muscle groups.American Psychiatric Association (2000)DSM-IV-TR: Tourette's Disorder.''Diagnostic and Statistical Manual of Mental Disorders'', 4th ed., ...

s *

Hypoglycemia Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose belo ...

Diagnosis

A wide array of phenomena may or may not resemble epileptic seizures, which may lead to people who do not have

epilepsy Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...

being misdiagnosed. Indeed, a significant percentage of people initially diagnosed with epilepsy will later heal. In one study, the majority of children referred to a secondary clinic with "fits, faints and funny turns" did not have epilepsy, with syncope (fainting) as the most common alternative. (Free full text online) In another study, 39% of children referred to a tertiary epilepsy centre did not have epilepsy, with staring episodes in mentally challenged children as the most common alternative. (Free full text online) In adults, the figures are similar, with one study reporting a 26% rate of misdiagnosis. (Free full text online) Differentiation of a non-epileptic attack from an epileptic seizure includes the patient keeping their eyes closed and rarely causing themselves harm (both more common in non-epileptic attacks)

References

External links

What are Non-Epileptic Seizures?
from Cleveland Clinic {{seizures and epilepsy Seizure types