Non-epileptic seizures (NES), also known as non-epileptic events, are paroxysmal 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 Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemica ...

psychological Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries bet ...

conditions. Physiological causes include fainting, sleep disorders, 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.

Terminology

The International League Against Epilepsy (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 A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended.

, toxins, eclampsia 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, also called startle syndrome *

Migraine Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...

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 ...

* Parasomnias, including night terrors *

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 o ...

*Repetitive or ritualistic behaviours * Tics *

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