What Are Seizures?
Seizures are episodes of altered electrical activity in the brain that can cause changes in behavior, mood, movements, and level of consciousness. If someone has two or more unprovoked seizures, they may be diagnosed as having epilepsy.
When pathways of communication between neurons (nerve cells) in the brain are disrupted, seizures can arise. A common cause is epilepsy, although many other seizure triggers have been identified— among them, very high fever, brain infection such as meningitis, electrolyte disturbances (for example, abnormal levels of sodium in the blood), use of certain street drugs, withdrawal from alcohol, poisoning or venomous bites or stings, and many more.
Certain triggers, specifically sleep deprivation and flashing lights, can be used for activation procedures during electroencephalogram (EEG) tests, which track and record the brain’s electrical activity. Photic (light) stimulation may be used in standard epilepsy tests as well.
Epileptic Seizures
About three million people in the United States are diagnosed with epilepsy. Epileptic seizures occur when certain patterns of abnormal electrical activity occur in the brain.
Symptoms of an epileptic seizure include contraction or jerking of muscles, loss of consciousness, weakness, anxiety, and staring. Some people with epilepsy notice that changes in the weather, exposure to certain smells, and even stress can act as a trigger for seizures.
In some cases, an episode of epileptic seizures is accompanied by a seizure aura. Auras are distinct perceptions felt around the time a seizure occurs. These perceptions can be auditory (hearing), olfactory (smell), visual, somatosensory, gustatory (taste), abdominal (similar to feeling nausea), motor, autonomic (shivers or goosebumps), or psychic (e.g., déjà vu).
There are several different kinds of seizures. Those most often associated with epilepsy are focal, or partial, seizures. Focal seizures involve only one area or one side of the brain.
Epileptic seizures can be diagnosed by an analysis of EEG recordings, medical history, physical observations, and sometimes video monitoring.
Focal aware seizures, also called focal partial seizure, can last for a few seconds to a couple of minutes and occur when a person is awake and aware while the seizures are occurring. Focal impaired awareness seizures can last for one or two minutes and impair consciousness. Sometimes these seizures are preceded by a focal aware seizure.
Psychogenic Nonepileptic Spells
Pseudo-seizures, also known as psychogenic non-epileptic spells (PNES), are events that mimic epileptic seizures but are not associated with the typical abnormal brain electrical activity that characterizes epileptic seizures.
PNES and epileptic seizures sometimes have similar features, like convulsions and alterations in behavior and consciousness.
PNES have a psychological origin and the condition is commonly associated with depression, post-traumatic stress disorder (PTSD), and personality disorders. A history of sexual or physical abuse is also a risk factor for the development of PNES.
PNES is more common among adult women. Additionally, individuals who have family members with epilepsy have a higher chance of developing PNES.
The rate of PNES is highly debated. It is estimated that two to 33 per 100,000 people in the United States have PNES. About 20% to 50% of those admitted in seizure monitoring units for extended EEGs have PNES rather than epilepsy.
Pseudo-seizures are not easily detected by observation alone. EEG and video monitoring are often required for definitive diagnosis.
Patients with PNES may have abnormalities that appear on structural brain images, but these are not associated with the episodes.
Symptoms, Diagnosis, and Treatment
Video-EEG monitoring is the standard diagnostic procedure for PNES. This test can record clinical findings to correlate with the brain’s electrical activity. For proper differentiation, a typical episode should be recorded, verified by the patient or family, and evaluated.
Common features:
PNES events typically occur when the individual is awake. They often last for longer than epileptic seizures and may end abruptly. Certain movements are also more commonly seen in PNES than in epileptic seizures, such as thrashing and pelvic thrusting. The absence of motor features and prolonged body limpness are more often seen in cases of PNES than cases of epilepsy.
Psychotherapy, including cognitive behavioral therapy, is regarded as the best approach to treating PNES. Antiepileptic drugs (AEDs) have not found to be effective.
The Role of Stress
While the evidence for stress as a cause of seizures is inconsistent, stress is a common factor in people who experience pseudo-seizures.
Stress is not always a bad thing. Optimal or eustress can promote adaptation and growth. However, stress that is overwhelming or chronic can lead to a variety of problems. Feeling stressed can cause a variety of physical responses, such as an upset stomach, chest pain, elevated blood pressure, headaches, sexual dysfunction, and problems sleeping.
A stress response, familiarly known as “fight or flight,” is appropriate in moments of urgency. However, prolonged stress can take a toll on the body, both physically and emotionally. Problems like depression, panic attacks, lack of motivation, and various forms of anxiety can arise.
Prolonged and chronic stress wears down the body’s natural defense mechanisms and increases the risk of several health problems including:
Managing Stress
Whether you are diagnosed with seizures or PNES, the episodes can be associated with stress. Managing stress is an important tool, used in combination with any treatment prescribed by your healthcare provider.
Learning to identify stressors and taking care of yourself physically and emotionally in stressful periods is a key part of reducing stress.
If you are dealing with anxiety and depression, your healthcare provider may also suggest anxiolytic (anti-anxiety) medication or antidepressants.
Physical activityPracticing relaxation techniques such as yoga or tai chiEnjoying hobbies, like reading a book or listening to a podcastSocializing with friends and familyVolunteering in your communitySeeking professional counseling
A Word From Verywell
Stress is a normal part of life, yet it impacts us physically, emotionally, mentally, and behaviorally. Stress can be associated with seizures, although it is more commonly associated with pseudo-seizures. If you are dealing with episodes of seizures or pseudo-seizures, understanding your stressors and managing stress can help in treating your condition.
If you are dealing with stress and symptoms of seizures, schedule a visit with your healthcare provider to find out about the diagnosis and a treatment plan best suited to your needs.
