When 22-year-old Shwetha (name changed) experienced frequent episodes of transient loss of consciousness in the last six months, the neurologist her parents consulted diagnosed it as epilepsy. However, on a detailed epilepsy work up it was found that her seizures were non-epileptic attacks. She was depressed as she had been forced her to quit her job. She displayed her resentment by resorting to seizure manifestation.
Similarly, 18-year-old Asha (name changed) was diagnosed with epilepsy and was started on anti-epileptic drugs four months ago, after she showed frequent episodes of transient loss of consciousness. Despite medication, her seizures were not controlled. In addition, she developed other complications. A detailed epilepsy work up found that she had pseudo-epileptic attacks. She was psychologically disturbed as her parents had not allowed her to join an air-hostess training course.
Wrongly diagnosed
These are just two examples of non-epileptic attack disorders that city-based neurologists are seeing. Doctors say that nearly 10% of patients, who come to the neurology out-patient department in hospitals are actually not suffering from seizure disorder. “Even in the best neurology units 5% to 10% of patients may be wrongly diagnosed as suffering from epilepsy. A majority of these will be suffering from pseudo-seizures medically referred to as paroxysmal non epileptic seizures (PNES),” said G.T. Subhas, immediate past president of Indian Epilepsy Association.
“Previously known as hysterical seizure or psychogenic seizure, non-epileptic seizures (NES) are paroxysmal events that appear similar to an epileptic seizure but do not involve abnormal, rhythmic discharges of neurons in the brain. Most of the times, this happens owing to psychological causes. There is lack of awareness about these,” said Dr. Subhas, who is also former dean and director, Bangalore Medical College and Research Institute (BMCRI).
In defence personnel
P. Satish Chandra, Senior Consultant Neurologist, Apollo Hospitals, Jayanagar, said pesudo-seizures are more common in adolescents and young women. “I have also seen some defence personnel mimicking such seizures. The cases that I have seen are mainly due to the urge to get back home and a need to get leave for some days or permanently quit the armed forces,” he said.
“Such patients usually mimic any type of seizures but convulsive attacks are more common. Psychogenic attacks may be deliberate for gains and to control their environments. They can also be symptom of psychiatric illness or depression. Sometimes it is also a ‘cry for help’ subconsciously when there is a history of physical or sexual abuse. Early and proper diagnosis is important for proper treatment,” he said.
Recording attacks
“Sometimes, even known epileptic patients produce pseudo-seizures and it is challenging for doctors to differentiate between these. One needs to be careful in making a diagnosis and the most important thing is to get the history of the seizure from an eyewitness. We also ask the family members to record the attack on their phones as it is easy to differentiate if we see it,” explained Dr. Chandra, who is also former director of NIMHANS.
“People who show non-epileptic attacks usually do so in the presence of someone and not during sleep. Also they never get injured (as they try to protect themselves) and the tongue biting is only on the tip and not on the sides. Once identified, such cases need counselling and further treatment,” he added.
