Posted: Monday, August 28, 2023

Psychogenic Non-Epileptic Seizures Often Are Misdiagnosed

Many of us have experienced physical symptoms from stress and anxiety, such as chest tightness, shortness of breath, heart racing or fainting. Likewise, psychogenic non-epileptic seizures (PNES) may look similar to an epileptic seizure. “Not all seizure-like spells are epileptic seizures. Epileptic seizures are caused by sudden, abnormal bursts of electrical activity in the brain that can affect body function, cause abnormal movements, and affect sensation, behavior or awareness. PNES are attacks that look like epileptic seizures, but they are the body’s response to extreme psychological or emotional distress often manifesting as physical symptoms,” Blount Memorial board-certified neurologist and epileptologist Dr. Faiz Rehmani said.

Psychogenic non-epileptic seizures often are misdiagnosed as epileptic seizures because they mimic the symptoms associated with epileptic seizures, such as shaking, jerking, staring or not responding. Patients presenting with these symptoms often are started on antiepileptic medications, and additional medications are added with time if their spells do not get better. In fact, about 80 percent of patients with PNES have been treated with antiepileptic drugs before a correct diagnosis of PNES is made. “When seizures are not responding to antiepileptic medications, it’s important to ask about a referral to an epilepsy specialist also known as epileptologist – a neurologist who subspecializes in the treatment of epilepsy and seizures. A misdiagnosis or delayed diagnosis can severely impact quality of life and take a significant toll on the emotional, financial and physical well-being of the patient,” Rehmani explained.

In general, 20 to 30 percent of patients with a prior diagnosis of epileptic seizures referred to epilepsy centers are found to have PNES. The most reliable test to diagnose PNES is video-EEG monitoring, which can only be performed by an epilepsy specialist. “By monitoring and analyzing simultaneous video and EEG recordings of the spells, a diagnosis can be made with near 100-percent certainty by experienced epilepsy specialists,” Dr. Rehmani added. Dr. Rehmani is the only board-certified epileptologist in Blount County, and one of only a handful in the East Tennessee region.

“Blount Memorial Hospital has an epilepsy monitoring unit whereby patients are admitted, and seizure medications are methodically withdrawn in a controlled and a safe environment, allowing us to record typical spells for characterization and classification of seizures. From there, we can determine whether a patient has epileptic seizures, PNES or both. In the event the seizures are epileptic, we can determine the type of epilepsy and tailor antiepileptic medications to the patient. We collaborate with Vanderbilt University Medical Center’s epilepsy division in Nashville to offer further advanced testing and treatment options, if necessary. We also can perform home video EEG monitoring for patients through a third party if the spells are less severe and do not warrant inpatient admission,” Rehmani explained.

Once a diagnosis of PNES is confirmed, the epileptologist will work with a psychiatrist, psychologist or therapist to provide individualized treatment to treat PNES. “We continue to follow patients and support them as needed after the diagnosis of PNES is confirmed. Blount Memorial Hospital and East Tennessee Medical Group - Neurology boast a team of dedicated subspecialized neurologists, advanced care providers and support staff who provide comprehensive care in a friendly community setting,” Dr. Rehmani said.

For more information about PNES or to schedule an appointment with Dr. Rehmani, call East Tennessee Medical Group at 865-984-3864.

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