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 usuall ...

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 los ...

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 or psychological 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 tests ...

, and heart arrhythmias. Psychological causes are known as psychogenic non-epileptic seizures. 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 pati ...

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 through research. They run the medical journals ''Epilepsia'', ''Epilepsia Open'', and ''Epileptic Disorders ''Epileptic Disor ...

(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, 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 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 is ...

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 *

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 a ...

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 dissociat ...

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 Paroxysmal kinesigenic choreoathetosis (PKC) also called paroxysmal kinesigenic dyskinesia (PKD) is a hyperkinetic movement disorder characterized by attacks of involuntary movements, which are triggered by sudden voluntary movements. The number of ...

*Repetitive or ritualistic 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 bel ...

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 electrica ...

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 Intellectual disability (ID), also known as general learning disability in the United Kingdom and formerly mental retardation, Rosa's Law, Pub. L. 111-256124 Stat. 2643(2010). is a generalized neurodevelopmental disorder characterized by signifi ...

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