NSE : Information on epilepsy: Non-epileptic seizures

Text-only version

Print this leaflet

Site map

Information on epilepsy: Non-epileptic seizures

The words non-epileptic seizures (NES) are used to describe seizures that often look like epileptic seizures but which have a different cause. Unlike epileptic seizures they are not caused by changes in brain activity. NES can take different forms and can have a range of causes.

What are seizures?

The term 'seizure' describes a sudden, short event where there is a change in a person's awareness of where they are or what they are doing, their behaviour or their feelings. The term is often used to describe epileptic seizures but there are many different types of seizure.

What causes seizures?

Seizures can happen for many different reasons. Some seizures are caused by conditions such as low blood sugar (hypoglycaemia), faints or by a brief change in the person's heart beat. Other seizures may be epileptic. Some people have more than one type of seizure. For example they could have both epileptic and non-epileptic seizures.

Epileptic seizures

Epileptic seizures are caused by a sudden, brief interruption in the way the brain is working. This is caused by a change in the electrical activity of the brain (how the brain sends messages to the body). What happens to a person during an epileptic seizure depends on where this change in activity is in the brain. This may affect the person's awareness and their behaviour.
More information on seizures
More information on epilepsy

What causes NES?

Some NES have a physical cause - relating to the body - such as fainting. Fainting is also called syncope. Some NES have a psychological cause - relating to the mind - such as panic attacks.

If NES happen for a physical reason it is often easier to diagnose the underlying cause. For example a faint may be diagnosed as being due to a physical problem in the heart.

The term NES is usually used to describe seizures with a psychological cause.

Finding the cause

Sometimes it can be very hard to find the reason why non-epileptic seizures start. For some people their NES may happen shortly after a specific stressful event. For others their NES may not start after any particular life event. This can make finding the cause difficult.

Some NES only occur when a person feels stressed or anxious. For other people their NES may start to happen in situations which are not seen as stressful.

What do NES look like?

What happens to the person during their NES can vary. What happens during an epileptic seizure can also happen during a non-epileptic seizure. During NES, like epileptic seizures, a person might fall and hurt themselves, convulse (make jerking movements) or be incontinent (wet themselves). Both types of seizures can happen suddenly and without warning. Because of this it can sometimes be hard to tell epileptic and non-epileptic seizures apart.

Psychological causes of NES

Any experiences that we have, whether good or bad, can have a deep and long-lasting effect on us. Everyone has their own way of dealing with their experiences. For some people, the NES they have are their brain's way of dealing with past painful experiences.

The causes of NES may be past experiences such as bereavements, divorce, abuse or other emotional difficulties. On-going stress may also cause them, such as work, family or money worries. Some people may not know the cause of their seizures. Some people may not think stress is a possible cause as it may be a normal part of their life.

Examples of NES with a psychological cause

The following are some examples of NES with a psychological cause.

Panic attacks

Panic attacks can occur in frightening situations or when remembering previous frightening experiences. They can also happen in situations that are expected to be distressing. Panic attacks can be very upsetting for the person having them. They may feel very anxious or frightened as the panic attack starts.

The physical effects of these attacks may include having difficulty breathing, sweating, palpitations (being able to feel your heartbeat) and trembling. The person may also lose consciousness and may have convulsions.

Over time panic attacks may happen even if the person is not in a frightening situation.

Cut off or avoidance attacks

This type of attack happens when a person finds it difficult to cope in a very stressful or emotionally difficult situation. This is more likely to happen when a person does not feel able to say they are finding it hard to cope. As with panic attacks, over time this might even happen in situations that are not stressful.

Delayed response to extreme stress

These attacks happen as a reaction to a very stressful event or situation such as being in a war or a disaster where the person may have seen other people dying. NES may be part of post-traumatic stress disorder - a condition that sometimes happens after a traumatic or stressful event.

During these attacks the person may cry, scream or have flashbacks to the event (sudden and vivid memories of these experiences). The person has no control over what they are doing and may have no memory of what happened.

How are NES diagnosed?

To help make a diagnosis the doctors need to take a personal history from the person. This includes looking at their neurological history (about their brain and nervous system), their psychological development (about their mind) and their current situation.

It can be hard to tell the difference between epileptic and non-epileptic seizures, as they can look very similar. Finding out about what the seizures look like, and as much as possible about the person having them, can help to find out what type of seizures the person has.
More information on diagnosis

Observation

The person who has had the seizure may not remember anything about it. It is very useful to have a description of what happens from someone who saw the seizure. The following information can be helpful:

Where was the person and what were they doing when the seizure happened?
What did the seizure look like?
How long did the seizure last?
How long did it take them to recover afterwards?
How did they behave before, during and after the seizure?

Blood tests

Blood tests can be used to check a person's overall health. They can also be used to see if the seizures have a physical cause like diabetes.

Electroencephalogram (EEG)

An EEG is a painless test that records the activity (electrical signals) of the brain. This activity is picked up by electrodes put on the person's head. The EEG records the brain activity that happens during the test.

Epileptic seizures are caused by changes in brain activity. If an epileptic seizure occurs while an EEG is being done, these changes in activity can be picked up. In non-epileptic seizures there are usually no such changes in brain activity and so there would be no changes picked up on the EEG recording. This may help to tell if the seizures are due to epilepsy or not.

Video telemetry

This involves having an EEG while being videoed at the same time. It is often done over a day or so in hospital.

This test can be used to compare what a person is doing during a seizure with what happens in the brain during the seizure. If a seizure occurs during the recording, often this can be helpful in telling the difference between epileptic and non-epileptic seizures.

Scans

Scans take a picture of the person's brain, which may show a physical cause for epileptic seizures. The scans themselves cannot diagnose epilepsy or non-epileptic seizures.

The scans might be computerised axial tomography (CAT or CT) or magnetic resonance imaging (MRI).

How are NES treated?

The right sort of treatment for each person depends on the cause of their seizures. The GP, neurologist, specialist nurse and psychiatrist or psychologist may help the person to decide on which sort of treatment is right for them.

If the NES have a psychological cause then the person may find psychological or psychiatric help useful. Psychologists and psychiatrists are trained in working with people who have conditions with a psychological cause.

Psychologists and psychiatrists will talk to the person about their past and look at the ways they have of coping with stressful events. This can help people to view past events differently and to view themselves and future stressful events in a more positive way. This may take several months as it can take time for a person to feel comfortable talking about their feelings. Often people make most progress if they have the understanding and support of their family and friends.

Will medication be prescribed?

A diagnosis of NES means that the seizures the person has are not epileptic. Because the seizures are not epileptic, there is no need to take anti-epileptic medication. Unless someone has both epileptic and non-epileptic seizures, any anti-epileptic drugs that have been prescribed are usually stopped when a diagnosis of NES is made (unless someone has both epileptic and non-epileptic seizures).

If anxiety or low mood is affecting the person other medication may be helpful.

Reactions to a diagnosis

Having a diagnosis of any condition can cause many different feelings and emotions. Some people may be relieved to have found out the cause of their seizures, but others may find it harder to come to terms with. It may be particularly difficult if the attacks have been previously diagnosed as being due to epilepsy. Knowing and accepting a diagnosis of NES can help to improve seizures.

Information and support may help the person to understand more about the diagnosis. Information may come from doctors, nurses, family or friends. Epilepsy organisations may also be able to provide information and support.

NSE has a confidential helpline on 01494 601 400. It is open Monday to Friday, 10am to 4pm.

First aid for NES

The general guidelines for first aid are the same for both epileptic and non-epileptic seizures.

When someone has a seizure it is important to keep them safe from injury. This may mean guiding them or moving them if they are in a dangerous place, or protecting their head if they have fallen. Whatever the cause it is best to allow the seizure to take its course and to stay with the person until they have recovered.
More information on managing seizures

Practical help

People who have seizures, whatever the cause, may be able to apply for benefits. Whether someone is able to get benefits or not depends on the effect that having these seizures has on their life. The need for extra help or support may continue as long as the seizures happen.

The risks connected with epileptic seizures and the safety tips that may help are equally important for NES.
More information on safety

Whether the diagnosis is of non-epileptic or epileptic seizures, the effect or impact of having seizures can be the same. NES, like epileptic seizures, can be sudden and unpredictable. Having seizures can affect many parts of a person's life.

UK Epilepsy Helpline: 01494 601400
Monday - Friday 10am - 4pm