Anxiety is a necessary human emotion designed to alert us to potential dangers and protect us from potential threats. For most people, feelings of anxiety are short-lived, but in some people, anxiety can become a chronic condition that greatly impacts quality of life.

Anxiety can cause a wide range of physical and mental symptoms, one of which may include psychogenic nonepileptic seizures (PNES), also called pseudoseizures.

In this article, we’ll explain what PNES are, how they differ from neurological seizures, and everything you need to know about anxiety and PNES.

A seizure is a brief period of uncontrolled electrical activity in the brain that can provoke a wide variety of changes in the body. Epilepsy is a chronic condition that causes unpredictable, recurrent seizures.

Seizures can be caused by a variety of triggers, including increased stress and anxiety. In fact, according to the British Epilepsy Association, stress is one of the most commonly self-reported seizure triggers in people with epilepsy.

Research has also shown that even in people without epilepsy, stress and anxiety can trigger what’s known as psychogenic nonepileptic seizures (PNES), or pseudoseizures. PNES are physiologically different from the neurological seizures found in epilepsy.

Pseudoseizures (PNES) aren’t the same type of neurological seizures that are caused by uncontrolled activity in the brain. Instead, PNES are an extreme response to stress and anxiety and are therefore considered psychiatric in nature.

According to the literature, PNES are classified as a type of functional neurological disorder (FND), or conversion disorder. Conversion disorders are triggered by emotional stress that causes physical symptoms that can’t be explained by other underlying conditions.

PNES most often occur in people who struggle to manage stress, anxiety, or other traumatic emotions through traditional coping strategies. When these emotions become overwhelming enough, the body may shut down as a defense mechanism. In some people, this can present as a PNES.

Sometimes, anxiety symptoms can manifest as a sudden, intense episode called a panic attack. Panic attack symptoms mimic many of the same symptoms you may feel when you’re anxious. However, you may also notice other intense symptoms, such as:

  • difficulty breathing or swallowing
  • sharp chest pains
  • chills or hot flashes
  • tingling or numbness in the extremities
  • feelings of panic or dread
  • feelings of disconnection from yourself or reality

Panic attacks aren’t a known cause of neurological seizures in people without epilepsy. However, there may be a correlation between panic attacks and PNES in people who experience them.

In one meta-analysis from 2018, researchers investigated the link between panic and hyperventilation and PNES. Eighteen studies were analyzed for a potential relationship between panic attacks, hyperventilation episodes, and PNES.

According to the results, up to 83 percent of individuals who had PNES also reported having accompanying panic attacks. In addition, the researchers found that up to 30 percent of individuals with voluntarily induced hyperventilation also experienced PNES.

While these results seem to suggest that panic attacks and panic attack symptoms may be a trigger for PNES, more research is still needed.

Panic attacks and PNES can both happen as a result of stress and anxiety. However, there are differences between the two experiences that distinguish them from each other.

Panic attacks

These episodes feature many, if not all, of the classic symptoms of anxiety. Panic attacks come on suddenly and pass within about 10 minutes. Many people who have panic attacks are still able to retain some level of function during the attack. However, symptoms vary from person to person.

PNES (pseudoseizures)

These episodes may not feature any symptoms of panic or anxiety at all. PNES tend to come on gradually and last longer than panic attacks. Many people who have PNES also experience panic symptoms, but some don’t.

In some cases, panic attacks can even be used as a diagnostic tool to help differentiate PNES from neurological seizures. In one study from 2014, researchers found that panic attack symptoms were more likely to appear in a PNES than in an epileptic seizure.

Although PNES and neurological seizures may appear similar, there are some differences in symptoms between the two conditions. For example, PNES may feature some of the symptoms found in neurological seizures, such as:

  • lowered awareness
  • loss of body control
  • flailing or thrashing
  • head arching
  • tongue biting

In addition to the symptoms above, PNES may also present with symptoms not traditionally found in neurological seizures, such as:

  • side to side head movements
  • nonsynchronized body movements
  • muscle contractions
  • closed or fluttering eyes
  • crying during the episode
  • avoidance behaviors
  • memory recall or avoidance

Another distinguishing factor of PNES is that these symptoms tend to appear more gradually and last longer than in neurological seizures.

If you have been experiencing PNES, your doctor will most likely refer you to an inpatient setting for testing. Video-electroencephalography (vEEG) is the most common diagnostic test for pseudoseizures.

During your inpatient stay, you will be connected to an electroencephalography (EEG) machine and a video monitoring system. The EEG machine tracks electrical activity in the brain, while the video monitoring system records any physical symptoms.

Any seizures or PNES that happen during your stay will be analyzed to determine the correct diagnosis. If you appear to have a seizure, but there’s no unusual brain activity, the most likely diagnosis is PNES.

In some cases, further imaging of the brain with a CT scan or MRI scan may be warranted. Your doctor may also want to perform further testing to eliminate any other underlying conditions, such as deficiency or infection.

They may also order additional psychological testing to narrow down any potential causes or triggers for your PNES.

Since PNES are psychological in nature, treatment of the underlying anxiety is important. Treatment options for anxiety-induced PNES may include:

  • Psychotherapy. Cognitive-behavioral therapy (CBT) is the first line of treatment for anxiety disorders. With CBT, an individual can learn how to better cope with stressful or anxious thoughts, feelings, and behaviors. This may help reduce the frequency of pseudoseizures. In addition, trauma-focused therapy may be helpful for individuals with trauma-based disorders who experience pseudoseizures.
  • Medications. Anti-epileptic drugs aren’t useful for pseudoseizures because these seizures aren’t neurological. Instead, selective serotonin reuptake inhibitors (SSRIs) may be prescribed to help reduce the symptoms of anxiety that can cause pseudoseizures. SSRIs have been found to be most effective when used in conjunction with psychotherapy.
  • Lifestyle. Both psychotherapy and medications can help an individual more easily cope with stress and anxiety. In turn, this can reduce the potential for emotionally triggered pseudoseizures. However, lifestyle changes can also help to reduce the symptoms of anxiety. Focusing on good sleep, a balanced diet, daily exercise, and mindfulness practices can further reduce anxiety and greatly improve quality of life.

Ultimately, you and your doctor will work together to come up with the best treatment approach for your personal situation.

While anxiety is unlikely to trigger neurological seizures in people without epilepsy, it can trigger PNES in individuals with underlying mental health conditions. Since these episodes have a psychiatric origin, treatment of the underlying anxiety can help reduce or eliminate these episodes.

If you’re concerned that you have been having PNES, reach out to your doctor for an appropriate diagnosis and treatment.

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