Neurologistshave long been aware of fake seizures. People would fall and shake and evenlose control of urine. Called pseudoseizures or psychogenic nonepilepticseizures, they can be involuntary due to psychological disturbances. Frighteningto witness as family and observers can attest. Yet the patient can still biteand lacerate lips and tongue and be incontinent of urine and bowel despite the EEGbrain waves remaining normal.  Pseudoseizure can also be voluntary-malingeredfaked seizures of which the patient is very aware. These can serve some practicalpurpose in the person’s life e.g. avoiding stressful situations. Thesepseudoseizures occur in up to a third of patients evaluated in epilepsyclinics. One-third of patients who suffer from true epilepsy have additionalpseudoseizures typically occurring during Their psychogenic nonepilepticseizures tend to occur when other people are present and during times ofheightened emotional stress when secondary gain is available. Patientsexhibiting feigned, or pseudoseizures, tend to have significant emotionalproblems. Schizophrenia, hysteria and hypochondriasis are common diagnoses.

Veteranswith psychogenic nonepileptic seizures tend to have higher rates of anxiety,post-traumatic stress disorder and chronic pain, as compared with veterans withtrue epileptic seizures. Civilians with psychogenic nonepileptic seizuresusually attribute their seizures to a past head injury, usually mild ones.

SelimBenbadis, MD reviewed this topic in Neurology 2019;92: 311-312.1 Psychogenicnonepileptic seizures (PNES) are so very common in epilepsy centers in the U.S.that they account for 30-40 percent of referrals.2

Treatmentresults of pseudoseizures are not encouraging. Adherence to psychotherapy andcognitive behavioral therapy was poor. Minorities and victims of abuse tend notto adhere to these therapies, but a better outcome is seen if they do adhereover time.

Anticonvulsantmedications are usually disappointing. Convincing psychiatrists/psychologiststhat their patients are sufferingpseudoseizures and not true epilepsy by neurologists can be difficult. Combinedpsychological and organic neurological on-going cooperative care can lead tosuccess.

1)   BenbadisSR. Psychogenic noonepileptic seizures, conversion, and somaic symptomdisorders. Neurology 2019;92: 311-312.

2)   BenbadisSR. The Problem of psychogenic symptoms in the psychiatric community indenial? Epilepsy Behav 2005;6:9-14.

LanceFogan, M.D. is Clinical Professor of Neurology at the David Geffen School ofMedicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view.“DINGS” is his first novel. Aside from acclamation on internet bookstoresites, U.S. Report of Books, and the Hollywood Book Review, DINGS has beenadvertised in recent New York Times Book Reviews, the Los Angeles TimesCalendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard covereditions.