A new study has revealed that a number of patients admitted for treatment of intractable seizures have stress-triggered symptoms rather than a true seizure disorder.
The researchers - a team of Johns Hopkins physicians and psychologists- based their claim on their clinical experience and observations.
AdvertisementThese patients - returning war veterans, mothers in child-custody battles and over-extended professionals alike - have what doctors are calling psychogenic non-epileptic seizures (PNES).
Their display of uncontrollable movements, far-off stares or convulsions, Johns Hopkins researchers say, are not the result of the abnormal electrical discharges in the brain that characterize epilepsy, but instead appear to be stress-related behaviours that mimic and are misdiagnosed as the neurological disorder.
One potent clue, the researchers note, is that antiseizure medications fail to stop these patients' symptoms, suggesting nothing is physically wrong with their brains' electrical activity. The researchers also say the diagnoses appear to be on the rise, at least by what they have seen in recent months.
In the past, behaviours like PNES were called "hysteria."
Now they are often considered by psychiatrists as part of a "conversion" disorder, in which the patient unconsciously converts emotional dysfunction into physical symptoms.
In some cases, those afflicted have become paralysed or blind because of emotional trauma. People at risk for pseudo-seizures are typically highly suggestible, the Hopkins scientists say, which is why physicians often have tried not to publicize or draw attention to the condition.
In recent months, headlines out of Western New York have described a group of more than a dozen female high school students who experienced uncontrollable tics and other movements, which many experts now believe are manifestations of a "contagious" psychiatric rather than neurological disorder.
In a new study, a team of neuropsychologists and neurologists at the Johns Hopkins University School of Medicine suggest that people with PNES don't necessarily experience more frequent or severe stressful events than people with epilepsy or neurologically healthy people.
However, they seem to lack effective coping mechanisms necessary to deal with those stresses and feel more distressed by them.
"These patients behave as if they have an organic brain disease, but they don't," said Jason Brandt, Ph.D., the study's senior investigator and a professor of psychiatry and behavioural sciences and neurology at the Johns Hopkins University School of Medicine.
"And it turns out that their life stresses weren't all that high, but they're very sensitive to stress and they don't deal with it well."
The Johns Hopkins researchers say they undertook the new study in an effort to learn why "psychogenic" symptoms so closely simulate a physical disorder and why some people are more susceptible to these behaviours than others.
Clearly, not every overwhelmed person develops seizure symptoms, they note, nor is it known how many people experience pseudo-seizures.
For the study the researchers evaluated 40 patients with PNES, 20 people with epilepsy and 40 healthy control volunteers, all of whom were asked to report the frequency of various stressful life events (both positive and negative) over the previous five years.
The research subjects then appraised the distress these events induced. Each group reported roughly the same number of stressful events, but the PNES group reported much higher distress levels than the other two groups.
The researchers found that the PNES group was less likely to plan a course of action to counter stressful life events. Those who used denial - the failure to acknowledge stressors - experienced greater distress than those who did not, illustrating the ineffectiveness of denial as a way of warding off anxiety, Brandt said.
Along with seizure symptoms, patients with PNES often have other problematic behaviours and unstable relationships. Many remain occupationally disabled and have high health care expenditures, even years after the non-epileptic nature of their events is identified, the authors reported.
The costs of believing you have epilepsy when you don't are high, Brandt noted.
The study has been published online in the journal Seizure.
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