Imagine, you suddenly feel like you have a seizure, your body is shaking, and maybe you lose consciousness... exactly like you have epilepsy. But you know, this doesn't always happen because of a seizure caused by some change in the electrical activity inside the brain. Sometimes it can be something different, but it can also look like that. Today we are going to talk about a condition like that, which doctors call `(Psychogenic Nonepileptic Seizure - PNES)`, or `(Functional Seizures - FS)`. Although this may seem a bit complicated, let's understand it simply.
What exactly is this `(PNES)`?
Simply put, PNES is a series of events that are very similar to the symptoms of epilepsy, that is, a series of events that come and go like a "fit." But the important thing is that these are not caused by abnormal electrical activity in the brain . Epilepsy is caused by a disturbance in the brain's electrical activity. But in PNES, that is not the case.
So why do these things happen? They actually occur as a response to certain things in our nervous system, that is, our body's sensory system . What are those things?
- Physical reasons: Perhaps an injury, something like persistent pain.
- Environmental influences: Severe psychological pressures from your surroundings, that is, stress.
- Traumatic events from the past: Perhaps there was an event that you can't forget and that had a profound impact on your mind.
The important thing is that if you have this condition, the "fit" you are having is real. It is not something you are doing on purpose or faking. You have no control over it when it happens, it is something that happens out of your control. It is very important to understand this first. This condition can be a huge disruption to your life, but it is possible to get help.
Sometimes doctors call this condition `(Functional Neurological Disorder - FND)`. The reason for this is that these symptoms can be explained as a disruption in the functioning of the brain's communication system. Some explain this as something like a problem with the ``software'' of a computer, that is, with the programs. This is also called ``psychogenic nonepileptic attacks``, ``episodes`` or ``spells``.
What are the symptoms of `(PNES)`?
The main symptom of this condition is the so-called "fit." But this can vary from person to person.
Some people may experience jerking and shaking of the whole body, as in ``Tonic-clonic seizures,`` which are the most severe forms of epilepsy. Others may experience jerking and twisting of the limbs. Sometimes, they may appear to lose consciousness for a short time, as in ``Absence seizures,`` or they may appear to suddenly fall to the ground, as in ``Drop attacks.`` The difference is that none of these are caused by abnormal electrical waves in the brain.
These are some of the most common symptoms of PNES:
- Changing patterns of body movements: limbs twitching and twisting in different ways.
- Body tremors while conscious: Sometimes, even though the body is shaking, you can still feel things happening around you to some extent.
- Closing your eyes and not responding.
- Whole-body convulsions lasting more than 10 minutes: Epileptic "fits" don't usually last this long.
- Loss of consciousness.
- Limbs moving in an uncoordinated manner.
- Pelvic movements.
- Head shaking rapidly from side to side.
In addition to this "fit", you may experience other symptoms due to underlying mental health issues. For example:
- Anxiety
- Depression
- Panic attacks
- Post-traumatic stress disorder (PTSD)
What are the causes of `(PNES)`?
Researchers believe that FS symptoms are caused by a combination of different stressors that affect your body, mind, and social relationships. This is also called the biopsychosocial model. This means that it can be caused by influences from all three areas: biological, psychological, and social.
In addition, these things can contribute to this condition:
- Difficulty understanding and expressing emotions: Some people cannot put into words exactly what they are feeling.
- Sensorimotor processing problems: This means that the brain has difficulty converting messages from our senses, such as our eyes and ears, into action.
- Incorrect responses to physical and mental stress: A tendency to become very upset and unable to bear even a small problem.
There is also a belief that genetic influences may play a role in the occurrence of this condition to some extent.
Often, an underlying mental health condition can be the cause of these "fits." The most common conditions seen are:
- Anxiety disorders with panic attacks
- Depressive disorders
- Dissociative disorders
- Mood disorders
- Personality disorders
- Post-traumatic stress disorder (PTSD)
- Somatic symptom disorder
- Substance use disorders
Risk factors for developing `(PNES)`
You may be at higher risk of developing this condition if you:
- If you have been subjected to physical, sexual, or emotional abuse or neglect as a child.
- If you have experienced a very difficult or traumatic event.
- If you suffer from a chronic illness such as chronic pain or fibromyalgia.
PNES most often begins in young adulthood, but it can begin at any age.
Possible complications due to `(PNES)`
When this "fit" occurs, you may lose all awareness or consciousness. Therefore, there is a high risk of accidents and injuries. In some cases, this can even be life-threatening. Imagine what would happen if this occurred while driving a vehicle or being in a high place.
You too may begin to withdraw from others and become socially isolated, out of ignorance, shame, or fear. This can cause you to distance yourself from your loved ones, friends, and the things you used to enjoy.
Having a fit like this can also have a big impact on your mental health. Having a fit (FS) can increase your risk of having suicidal thoughts. If you are having these thoughts, please get help. You are not alone. Talk to someone you trust, or see a doctor or qualified counselor. You never have to wait until you are in a crisis to get help.
How do doctors diagnose PNES?
PNES can be difficult to diagnose because the symptoms are very similar to epilepsy. Your doctor can diagnose it by using a video (EEG - electroencephalogram) test to record a seizure.
An EEG measures and records the electrical signals in your brain. When you do an EEG, a technician places small metal plates (electrodes) on the skin of your scalp. These electrodes are connected to a machine that gives the doctor information about your brain activity.
If the "fit" you are having is `(PNES)`, meaning it is a functional problem, the `(EEG)` test will show that the electrical activity in the brain is normal even when the "fit" occurs. However, in someone with epilepsy, the `(EEG)` will show abnormal electrical activity when the "fit" occurs.
Many people with this condition are initially misdiagnosed as having epilepsy. Also, very rarely, someone can have both epileptic "fits" and ``PNES''.
How is `(PNES)` treated?
Research has shown that a type of psychotherapy called Cognitive Behavioral Therapy (CBT) is the most effective treatment for PNES .
Your doctor will also help you manage any underlying conditions (such as depression) that may be causing your fits. This may include taking an antidepressant medication, as prescribed by your doctor, in addition to CBT.
Most importantly, antiseizure medications are not effective in treating this condition (PNES).
A little more about `(CBT)` treatment for `(PNES)`
Cognitive Behavioral Therapy (CBT) is a type of counseling that helps you learn about how your mind and body respond to different triggers. It also helps you understand how your thoughts affect your feelings and behaviors. A mental health counselor can help you identify and change your unhealthy thoughts, feelings, and behaviors, and help you cope more effectively with stressful events.
If you feel that CBT is not a good fit for you, your doctor may recommend "FIT" or other counseling methods to help you manage your mental challenges.
During your counseling session, you will meet with your counselor regularly. Together, you will learn more about how your thoughts affect your feelings and your "fit." Then, together, you will set goals and work to achieve them. When managing PNES, you may have goals such as:
- Learning more about your diagnosis.
- Identifying past or present stressors and finding ways to let go of them.
- Identifying common triggers for a "fit" and managing them.
- Developing emotional management skills (e.g. relaxation techniques).
- Rebuilding the quality of your life (relationships, education, work, etc.).
It's okay if your goals aren't exactly the same as this. Everyone's goals are different depending on their needs.
For adults, your doctor may suggest a program called ``Neurobehavioral therapy.'' This is a type of therapy that uses a workbook, similar to taking a class. You attend weekly meetings, which consist of about 45 minutes of therapy. You are also given ``practice assignments'' to do at home. This may include activities such as keeping a journal or attending a social event. Each week, you can build on what you have learned and continue this until you have mastered certain skills.
When should I see my doctor?
Counseling can bring up a lot of feelings that you may have been holding back or not even thinking about. If you feel like your emotions are getting out of control, or if you feel unsafe, remember that your counselor is there to help you on this journey. It is very important to contact your doctors to discuss any questions you may have about your treatment or to help you.
What can I expect after treatment for `(PNES)`?
PNES is a condition that can have a significant impact on your life. However, with proper diagnosis and treatment, symptoms can improve.Some people report that their "fits" have completely disappeared or have been greatly reduced by following their doctor's advice and actively participating in counseling. Your doctor can give you the best information about what to expect based on your situation.
Finding out that stress is causing your PNES can be even more stressful! But it doesn't have to be. Your healthcare team is there to help you understand your diagnosis without judgment. Together, you can develop a plan to reduce your symptoms and treat any underlying mental health conditions.
Your doctors will encourage you to practice the skills you learn during your counseling sessions. Like anything in life, the more effort you put in, the better your results will be. It takes time to develop new skills, so don't be discouraged if you don't get it right right away. Your doctors will support you every step of the way.
Finally, what to remember (Take-Home Message)
PNES is a real condition, it is not something you do on purpose. Although it can be difficult to diagnose, it can be managed to a great extent with proper diagnosis and treatment, especially with CBT. If you have these symptoms, don't be ashamed or afraid to seek medical advice. Remember, you are not alone, and help is available. Your mental health is just as important as your physical health. So take care of that too.
👩🏽⚕️ Additional questions (FAQs)
💬 Is lymphedema caused by swelling in both legs?
That's just one part of the puzzle! Lymphedema is a condition in which an arm or leg (often just one side) becomes unusually swollen due to a blockage or damage to the lymphatic system, which carries excess fluid (anti-proteins) from our bodies. This fluid builds up under the skin instead of draining back out.
💬 When do these lymph nodes get blocked?
Most of the time in the world, this (Secondary Lymphedema) occurs in 'cancer' patients. Especially when the lymph nodes in the armpit are removed during breast cancer surgery, the arm on that side becomes completely swollen (Arm lymphedema). Also, in countries like ours, when 'filariasis', which is transmitted by mosquitoes, blocks these vessels, the legs swell.
💬 Can a swollen arm/leg be restored to normal?
Unfortunately, there is no permanent cure for this. However, it is possible to control its severity. This requires manual lymphatic drainage, tight compression stockings/garments, and continued specific exercises.
`PNES, functional seizures, nonepileptic seizures, psychogenic seizures, seizures, stress, non-epileptic seizures, mental health, fit
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