THE PSEUDO SEIZURE & TREMOR

Introduction

A pseudo seizure, also known as a psychogenic non-epileptic seizure (PNES), is a condition that causes symptoms similar to an epileptic seizure, but without the physical changes in the brain typically seen in epilepsy. The cause of PNES is believed to be psychological or psychiatric and may be related to stress, trauma, or other emotional or mental health issues.

People with PNES may experience convulsions, body jerks, staring spells, and other symptoms that are similar to those of an epileptic seizure. However, these symptoms are not caused by electrical activity in the brain and cannot be treated with traditional antiepileptic medications. Instead, treatment for PNES often involves psychological and psychiatric therapies, such as counselling and therapy, to address the underlying psychological or emotional issues that are contributing to the seizures.

It is important to accurately diagnose PNES, as misdiagnosis can lead to unnecessary and potentially harmful medical interventions. A diagnosis of PNES is usually made through a combination of medical history, physical examination, and diagnostic tests, such as an EEG (electroencephalogram), which can help to distinguish between PNES and epilepsy.

1. Difference between Pseudo Seizure and Tremor

Pseudo-seizure and a Tremor are not the same things.

A pseudo-seizure is a type of seizure that mimics the symptoms of an epileptic seizure but is not caused by abnormal electrical activity in the brain. As mentioned earlier, the cause of a pseudo-seizure is believed to be psychological or psychiatric, and the symptoms may include convulsions, body jerks, and staring spells.

A tremor, on the other hand, is a type of involuntary muscle movement that causes rhythmic shaking. Tremors can be caused by a variety of factors, including neurological conditions, such as Parkinson’s disease, or other medical conditions, such as alcohol withdrawal or liver disease. Tremors can also be a side effect of certain medications or a symptom of an anxiety disorder.

A person can experience both a pseudo-seizure and a tremor, but they are not the same thing. Accurate diagnosis and treatment of the underlying cause are important for both conditions.

2. Types of Seizures

There are many different types of seizures, which can be differentiated based on their symptoms, causes, and the areas of the brain affected. Some of the most common types of seizures include:

• Generalized seizures: These are seizures that affect both sides of the brain and can cause loss of consciousness, body jerks, and convulsions. Examples of generalized seizures include tonic-clonic seizures (formerly known as grand mal seizures) and absence seizures (formerly known as petit mal seizures).
• Partial (focal) seizures: These are seizures that originate in one specific area of the brain and can cause changes in sensation, movement, and behaviour. Examples of partial seizures include simple partial seizures, in which the person remains conscious and complex partial seizures, in which the person loses consciousness.
• Secondarily generalized seizures: These are seizures that begin as partial seizures and then spread to both sides of the brain, becoming generalized seizures.
• Status epilepticus: This is a potentially life-threatening condition in which a person has a prolonged seizure or a series of seizures without regaining consciousness in between.
• Febrile seizures: These are seizures that occur in children and are triggered by a high fever.

Diagnosis of the type of seizure a person is experiencing is important for determining the most appropriate treatment. The diagnosis is typically based on a thorough medical history, physical examination, and diagnostic tests, such as an EEG (electroencephalogram), which measures the electrical activity of the brain. In some cases, imaging tests, such as an MRI (magnetic resonance imaging) or CT (computed tomography) scan, may also be performed to identify any structural abnormalities in the brain that could be contributing to seizures.

3. What does a Pseudo-Seizure Look like?

A pseudo seizure, also known as a psychogenic non-epileptic seizure (PNES), can look similar to an actual epileptic seizure. Some common symptoms of a pseudo-seizure include:

• Convulsions: The person may experience body jerks or convulsions that mimic the movements seen in an actual epileptic seizure.
• Staring spells: The person may have a blank or vacant expression and may seem to be staring into space.
• Unresponsiveness: The person may seem unresponsive or unaware of their surroundings during the episode.
• Loss of consciousness: In some cases, the person may lose consciousness during the episode.
• Emotional distress: The person may appear to be in distress or may cry or scream during the episode.

While the symptoms of a pseudo-seizure may resemble those of an actual seizure, they are not caused by abnormal electrical activity in the brain. Instead, they are thought to be related to psychological or emotional factors, such as stress, trauma, or other mental health issues.

It can be challenging to distinguish between a pseudo seizure and an actual epileptic seizure, as the symptoms can be very similar. A diagnosis of a pseudo seizure is typically made through a combination of medical history, physical examination, and diagnostic tests, such as an EEG (electroencephalogram), which can help to distinguish between the two.

4. What can Trigger PNES?

Psychogenic non-epileptic seizures (PNES) can be triggered by a variety of physical, emotional, and psychological factors. Some common triggers include:

• Stress: Stressful events or ongoing stress can trigger or worsen PNES in some people.
• Trauma: Traumatic events, such as abuse, neglect, or a serious accident, can trigger or worsen PNES in some people.
• Anxiety and depression: Anxiety and depression can trigger or worsen PNES in some people.
• Substance abuse: Substance abuse, particularly alcohol and recreational drugs, can trigger or worsen PNES in some people.
• Sleep deprivation: Lack of sleep can trigger or worsen PNES in some people.
• Physical illness: Certain physical illnesses, such as a viral illness or a headache, can trigger PNES in some people.
• Hormonal changes: Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can trigger or worsen PNES in some people.

It is important to note that triggers can vary from person to person and may not be the same for everyone. Keeping a seizure diary can help identify any triggers for your PNES and can assist in the development of a comprehensive treatment plan.

It is important to work with a healthcare provider to develop a comprehensive treatment plan that addresses the underlying triggers and causes of PNES, as well as the physical and emotional symptoms of the condition. This may include therapy, medication, and lifestyle changes.

5 . Early Warning Signs of a Seizure, Can Patient Realise its Onset?

Some people with epilepsy may experience warning signs, or aura, before a seizure. An aura is a specific sensation or feeling that occurs before a seizure and can be a sign that a seizure is about to occur. The type of aura experienced may vary from person to person and can include:

• Sensory aura: A person may experience changes in their vision, hearing, touch, or smell before a seizure.
• Emotional aura: A person may experience sudden, intense emotions, such as fear, anger, or joy, before a seizure.
• Deja vu: A person may have a strong sense of déjà vu, or feeling that they have experienced a situation before, before a seizure.
• Unusual sensations: A person may experience strange or unusual sensations, such as tingling, numbness, or a feeling of electricity in their body, before a seizure.
• Visual aura: A person may see flashing lights, bright colours, or geometric patterns before a seizure.

Not all people with epilepsy experience auras before a seizure. Additionally, not all auras are the same for every person, and some people may experience more than one type of aura before a seizure. If you experience auras before a seizure, it is important to inform your healthcare provider, as this information can help them make a more accurate diagnosis and develop an effective treatment plan.

6. Signs of a Seizure

Seizures are characterized by changes in behaviour, consciousness, and/or muscle activity. The specific symptoms of a seizure can vary depending on the type of seizure and the area of the brain affected. Some common signs of a seizure include:

• Convulsions or uncontrolled muscle contractions: This is the most common and well-known sign of a seizure. During a convulsive seizure, the person may shake or jerk their limbs, or experience twitching or stiffness.
• Loss of consciousness: The person may lose consciousness or become confused during a seizure.
• Alterations in behaviour or emotion: The person may display unusual or unexpected behaviour, such as laughing, crying, or making strange noises.
• Abnormal sensations: The person may experience strange sensations, such as a strange taste in the mouth, a rising or falling sensation, or a sense of déjà vu.
• Unusual movements: The person may experience repetitive or involuntary movements, such as lip smacking, eye fluttering, or picking at clothing.
• A staring spell: The person may appear to be staring into space and unresponsive to their surroundings.
• Loss of bladder or bowel control: The person may involuntarily release urine or faeces during a seizure.

It is important to note that the symptoms of a seizure can vary greatly from person to person and may not be the same for everyone. If you suspect that you or someone you know is experiencing a seizure, it is important to seek medical attention as soon as possible. A healthcare provider can diagnose the type of seizure and recommend the appropriate treatment.

7. After Effects of PNES

The after-effects of a psychogenic non-epileptic seizure (PNES) episode can vary from person to person but may include physical and emotional symptoms. Some common after-effects of PNES include:

• Fatigue: Many people experience fatigue or exhaustion after a PNES episode, which can last for several hours or even days.
• Muscle soreness: Muscle soreness or stiffness is common after a PNES episode, especially if the seizure involved physical activity, such as convulsions or muscle stiffness.
• Emotional distress: PNES can be a traumatic experience, and many people experience feelings of distress, anxiety, or depression after an episode.
• Confusion: People may feel confused or disoriented after a PNES episode, especially if the seizure was accompanied by a loss of consciousness.
• Physical injuries: In some cases, physical injuries can occur during a PNES episode, such as cuts, bruises, or broken bones, which can result in aftereffects such as pain or swelling.

It is necessary to remember that the after-effects of a PNES episode can be managed with appropriate care and treatment. This may include rest, over-the-counter pain medication, and emotional support from friends, family, or a mental health professional. In some cases, medication or therapy may be recommended to help manage the physical or emotional aftereffects of PNES.

8. Best Practices to Treat Seizure Patients During Episode

If you witness someone having a seizure, there are several steps you can take to help:

• Keep the person safe: Move any sharp or hard objects away from the person and make sure they are on a safe and flat surface, such as the floor.
• Do not try to restrain the person: Allow the person to move and convulse during the seizure, as trying to hold them still can increase the risk of injury.
• Turn the person onto their side: This will help prevent choking if the person vomits during the seizure.
• Loosen tight clothing around the neck: This will help the person breathe more easily.
• Time of the seizure: Seizures usually last a few minutes, but it is important to keep track of the time in case the seizure lasts longer or if multiple seizures occur in a row.
• Stay with the person: Remain with the person until the seizure has ended and they are fully conscious and alert.
• Do not put anything in the person’s mouth: This is a common myth and can cause injury.

It is important to seek medical attention for anyone who has a seizure, especially if it is their first time experiencing a seizure or if the seizure lasts for an extended period. Additionally, people with epilepsy need to carry a medical identification card or wear a medical alert bracelet that identifies their condition and any specific medical needs or

9. After Effects of PNES

The after-effects of a psychogenic non-epileptic seizure (PNES) episode can vary from person to person but may include physical and emotional symptoms. Some common after-effects of PNES include:

• Fatigue: Many people experience fatigue or exhaustion after a PNES episode, which can last for several hours or even days.
• Muscle soreness: Muscle soreness or stiffness is common after a PNES episode, especially if the seizure involved physical activity, such as convulsions or muscle stiffness.
• Emotional distress: PNES can be a traumatic experience, and many people experience feelings of distress, anxiety, or depression after an episode.
• Confusion: People may feel confused or disoriented after a PNES episode, especially if the seizure was accompanied by a loss of consciousness.
• Physical injuries: In some cases, physical injuries can occur during a PNES episode, such as cuts, bruises, or broken bones, which can result in aftereffects such as pain or swelling.

It is necessary to remember that the after-effects of a PNES episode can be managed with appropriate care and treatment. This may include rest, over-the-counter pain medication, and emotional support from friends, family, or a mental health professional. In some cases, medication or therapy may be recommended to help manage the physical or emotional aftereffects of PNES.

10. Risk Factors Involved in PNES

Several risk factors have been associated with the development of psychogenic non-epileptic seizures (PNES), including:

• Mental health conditions: People with depression, anxiety, and post-traumatic stress disorder (PTSD) are at higher risk of developing PNES.
• Childhood trauma: A history of childhood abuse or neglect is a risk factor for PNES.
• Physical health conditions: Chronic pain, physical illness, or a history of head injury can increase the risk of PNES.
• Family history: A family history of epilepsy or PNES may increase the risk of developing the condition.
• Substance abuse: Substance abuse, including alcohol and drug use, is a risk factor for PNES.
• Stress: High levels of stress or trauma can trigger PNES in some people.

It is important to note that not everyone with these risk factors will develop PNES, and some people with PNES may not have any of these risk factors. A combination of medical history, physical examination, and diagnostic tests, such as an EEG (electroencephalogram), are typically used to diagnose PNES and determine the best course of treatment.

11. No Specific Timings for Seizures, can Start at any Time

Seizures can occur at any time, and there is no specific time when seizures are more likely to occur. People with epilepsy may have seizures at any time of the day or night, and the frequency and timing of seizures can vary greatly from person to person. Some people may experience seizures only occasionally, while others may have multiple seizures each day.

Seizures can be triggered by various factors, such as lack of sleep, stress, certain medications, alcohol or drug use, changes in routine, and high fevers, among others. Individuals with epilepsy need to work with their healthcare provider to identify their triggers and develop a plan to manage them.

Additionally, some people with epilepsy may experience seizures that follow a specific pattern or rhythm, such as happening at the same time each day or during certain activities, while others may not experience any apparent way or rhythm in their seizures. Understanding the pattern and timing of seizures can help manage epilepsy and reduce the risk of seizures and their impact on daily life.

12. Who Treats PNES?

Psychogenic non-epileptic seizures (PNES) are a curable ailment. The goal of treatment is to help manage the physical symptoms of the seizures and to address any underlying psychological or emotional issues that may be contributing to the seizures.

A multi-disciplinary approach to treatment is typically recommended for PNES, involving a team of healthcare professionals including:

• Neurologist: A neurologist is a doctor who specializes in the diagnosis and treatment of neurological disorders, including PNES.
• Psychiatrist: A psychiatrist is a doctor who specializes in the treatment of mental health conditions, including the emotional and psychological factors that may be contributing to PNES.
• Psychologist: A psychologist is a mental health professional who specializes in the treatment of psychological and emotional issues.
• Physical therapist: A physical therapist can help manage physical symptoms related to PNES, such as muscle weakness or coordination problems.

13. Treatment Options for PNES

• Medication: Antidepressant or antianxiety medication may be prescribed to help manage emotional symptoms that may be contributing to PNES.
• Psychotherapy: Talking therapy, such as cognitive behavioural therapy (CBT) or eye movement desensitization and reprocessing (EMDR), can help address psychological or emotional issues that may be contributing to PNES.
• Mindfulness and relaxation techniques: Techniques such as mindfulness, deep breathing, and progressive muscle relaxation can help reduce stress and improve overall well-being.
• Lifestyle changes: Making changes to your daily routine, such as reducing stress and improving sleep habits, may help reduce the frequency and severity of PNES.
• Group therapy: Group therapy can provide support and understanding from others who are experiencing similar challenges with PNES.

Treatment for PNES may take time, but with the right support and care, it is possible to manage the physical and emotional symptoms of the condition.

14.  Medications to Treat PNES?

Medications can be used to treat some of the symptoms of psychogenic non-epileptic seizures (PNES), but they do not cure the underlying condition. The type of medication used to treat PNES will depend on the specific symptoms and underlying causes of the condition. Some common medications used to treat PNES include:

• Antidepressants: Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can be used to treat depression and anxiety, which are often associated with PNES.
• Anticonvulsants: Anticonvulsants, such as carbamazepine and valproic acid, can be used to treat seizures and can help reduce the frequency and severity of PNES.
• Anti-anxiety medications: Anti-anxiety medications, such as benzodiazepines, can be used to treat anxiety and panic attacks, which are often associated with PNES.
• Beta-blockers: Beta-blockers, such as propranolol, can be used to treat physical symptoms of PNES, such as rapid heartbeat and sweating.

It is important to work with a healthcare provider to determine the most appropriate medication for your specific symptoms and underlying causes. The use of medication should be combined with other treatments, such as therapy and lifestyle changes, to address the underlying psychological and emotional factors that contribute to PNES.

15. Natural Treatment/Remedies for PNES

There is no one specific “natural” treatment for psychogenic non-epileptic seizures (PNES), but some complementary or alternative therapies may be used in conjunction with traditional medical treatments to help manage symptoms. However, it is important to remember that not all alternative or complementary therapies have been scientifically proven to be effective, and some may even be harmful.

Here are some alternative or complementary therapies that some people with PNES may find helpful:

• Mind-body techniques: Techniques such as mindfulness, meditation, or yoga may help reduce stress and improve mental well-being, which can help manage symptoms of PNES.
• Herbal remedies: Some herbal remedies, such as valerian root, passionflower, or chamomile, may help manage symptoms of anxiety or depression that may be contributing to PNES.
• Acupuncture: Acupuncture is a form of traditional Chinese medicine that involves the insertion of fine needles into specific points on the body to promote healing and improve physical and emotional well-being.
• Massage therapy: Massage therapy can help reduce muscle tension, improve circulation, and promote relaxation, which may help manage symptoms of PNES. 16.   Useful Household Herbs and Spices to Help Reduce Seizure Problem
• There is limited scientific evidence to support the use of herbs and spices as a treatment for seizures. However, some herbs and spices have been traditionally used for their potential benefits for people with epilepsy and other neurological conditions, and some people may find relief from using them. Here are a few herbs and spices that have been traditionally used for their potential benefits for people with epilepsy:
  • Valerian root: Valerian root has been traditionally used to calm the nervous system and improve sleep, and it has been suggested as a potential treatment for seizures.
  • Passionflower: Passionflower has been traditionally used to calm the nervous system and reduce anxiety, and it has been suggested as a potential treatment for seizures.
  • Bacopa: Bacopa has been traditionally used in Ayurvedic medicine to improve cognitive function and reduce stress, and it has been suggested as a potential treatment for seizures.
  • Ashwagandha: Ashwagandha has been traditionally used in Ayurvedic medicine to improve overall health and reduce stress, and it has been suggested as a potential treatment for seizures.
  • Ginger: Ginger has been traditionally used to reduce inflammation and improve digestion, and it has been suggested as a potential treatment for seizures.

  It is important to note that herbs and spices are not a substitute for conventional medical treatments for seizures and should not be used as the sole treatment for epilepsy. If you have epilepsy or another neurological condition, it is important to talk to your healthcare provider about your treatment options, including any potential risks and benefits of using herbs and spices.

17. Vitamin Deficiencies can Contribute to SEIZURES

Certain vitamin and mineral deficiencies can increase the risk of seizures. For example:

• Thiamine (vitamin B1) deficiency: Thiamine is important for proper brain function, and a deficiency can lead to a condition known as Wernicke-Korsakoff syndrome, which can cause seizures.
• Magnesium deficiency: Magnesium is important for proper nerve and muscle function, and a deficiency can increase the risk of seizures, particularly in people with epilepsy.
• Vitamin D deficiency: Vitamin D is important for proper bone and muscle health, and a deficiency has been linked to an increased risk of seizures, particularly in children.
• Zinc deficiency: Zinc is important for proper brain function, and a deficiency has been linked to an increased risk of seizures.

It is important to maintain a balanced and nutritious diet to ensure an adequate intake of vitamins and minerals, and to talk to your healthcare provider if you have concerns about vitamin and mineral deficiencies. However, it is important to note that vitamin and mineral deficiencies are just one of many factors that can contribute to seizures, and addressing deficiencies may not necessarily prevent seizures in all cases.

18. How Painful is a Seizure

Seizures themselves are not typically painful, but they can cause discomfort and physical stress to the body. Some people may experience a feeling of fear or anxiety during a seizure, and others may feel a sense of confusion or disorientation after a seizure.

However, some types of seizures, such as tonic-clonic seizures, can cause muscle contractions and spasms that can result in physical injuries, such as cuts, bruises, or broken bones. Additionally, certain types of seizures, such as those that involve falling or convulsions, can result in head injury if the person falls and hits their head.

It is also possible for people with epilepsy to experience ongoing pain or discomfort related to the seizures themselves, or as a result of the medications used to treat epilepsy. This is why individuals with epilepsy need to work closely with their healthcare provider to manage their condition and reduce any associated pain or discomfort.

19. Do PNES Seizures Go Away?

Psychogenic non-epileptic seizures (PNES) can be a chronic condition, and some people may experience multiple episodes over a long period. However, with appropriate treatment and management, many people with PNES can reduce the frequency and severity of their seizures and improve their overall quality of life.

The treatment of PNES typically involves a combination of psychotherapy and medication, as well as lifestyle changes and stress management techniques. Psychotherapy may include talk therapy, such as cognitive behavioural therapy (CBT), which can help people with PNES identify and manage the psychological and emotional issues that may be contributing to their seizures. Medication may be used to manage symptoms of anxiety, depression, or other psychological conditions that may be contributing to PNES.

In addition to therapy and medication, lifestyle changes and stress management techniques, such as exercise, relaxation techniques, and mindfulness practices, can also help manage PNES. Some people may also benefit from support groups or counselling to help cope with the emotional and social challenges of living with PNES.

It is important to work with a healthcare provider to develop a comprehensive treatment plan that is tailored to your individual needs and goals. With the right combination of treatment and support, many people with PNES can reduce the frequency and severity of their seizures and improve their overall quality of life.

20. What is CBT?

Cognitive behavioural therapy (CBT) is a form of talk therapy that is based on the idea that our thoughts, feelings, and behaviours are all interconnected. CBT aims to help people identify and change negative or unhelpful thought patterns and behaviours that may be contributing to emotional or psychological problems.

CBT is typically conducted by a licensed mental health professional, such as a psychologist, licensed clinical social worker, or licensed professional counsellor. The therapy usually involves weekly sessions that last about 50-60 minutes each.

During CBT, the therapist will work with the person to identify negative thoughts and behaviours and to develop strategies to challenge and change these patterns. This may involve techniques such as:

• Thought journaling: Writing down and examining negative thoughts to help identify patterns and underlying beliefs.
• Challenging negative thoughts: Examining the evidence for and against negative thoughts, and developing a more balanced perspective.
• Re-framing negative thoughts: Replacing negative thoughts with more positive or realistic thoughts.
• Behavioural experiments: Trying out new behaviours to see how they affect thoughts and feelings.
• Exposure therapy: Gradually facing feared situations to reduce anxiety and build confidence.

The number of sessions and length of CBT can vary depending on the individual’s needs and goals. CBT is effective in treating a variety of mental health conditions, including anxiety, depression, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).

It is essential to work with a qualified mental health professional with training and experience in CBT to ensure you receive the best possible treatment.

21. Can One Live a Normal Life with PNES?

Yes, many people with psychogenic non-epileptic seizures (PNES) can live a fulfilling and normal life with appropriate treatment and management. While PNES can be a chronic condition, many people can reduce the frequency and severity of their seizures with the right combination of therapy, medication, and lifestyle changes.

It is important to work with a healthcare provider to develop a comprehensive treatment plan that is tailored to your individual needs and goals. Treatment may involve a combination of psychotherapy, such as cognitive behavioural therapy (CBT), medication, and lifestyle changes.

In addition to treatment, developing a strong support network, practising self-care and stress management techniques, and engaging in physical activity can also help improve the quality of life for people with PNES. With the right combination of treatment and support, many people with PNES can manage their symptoms and lead a fulfilling life.

It is also important to remember that everyone’s experience with PNES is unique, and some people may experience more challenges than others. However, with the right support and resources, many people with PNES can overcome these challenges and lead fulfilling and productive lives.