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Psychogenic Seizures — What are They, How Can They be Diagnosed and Treated?

Psychogenic Seizures — What are They, How Can They be Diagnosed and Treated?


Thank you, and thank
you all for coming. Epilepsy is one of the most
misunderstood of diseases. Even the word seizure
comes from being seized by supernatural forces–
the gods or the devils, depending upon which
century you’re in. And if epilepsy
is misunderstood, then the condition psychogenic
nonepileptic seizures is even more misunderstood. In fact, very few of my
patients have ever heard of it, and probably most
primary care doctors have not heard of it as well. And yet, it’s pretty common–
at least in referral centers, it’s very common. And it is often misdiagnosed,
and it is often mistreated. So it’s great to be invited
to have an opportunity to talk about this
misunderstood condition and see if we can
shed some light and answer some questions. We have with us a moderator,
Dr. Ariela Karasov. And I will turn over
to you for questions. And please feel free to
direct questions to any of us. And we will feel free to
answer any of the questions as best we can. Well, thank you, all of you,
for joining us this evening. And thanks to the
audience for being here. We’ll start with
you, Dr. Fisher. Before talking about psychogenic
nonepileptic seizures, or PNES, and how they differ
from epileptic seizures, could you say a word about
what are epileptic seizures? Sure. An epileptic seizure is an
electrical storm in the brain. Normally the brain cells
function fairly independently, with a lot of chatter. If they fire too synchronously,
too much together in too high a surge of voltage,
then a seizure results. And the type of seizure
depends upon where in the brain that abnormal
electricity comes from. If it comes from the
motor control area, you may have twitching
of your hand. If it comes from
the visual area, you may see lights or
visual hallucinations. If it comes from
the temporal lobes on the side of the brain,
the most seizure-prone part, then there may be
fumbling, confusion, loss of memory, robot-like
behaviors called automatisms. And if they spread to
the entire brain, then you have what is often
called the grand mal, or more officially, the
tonic-clonic seizure, with stiffening and shaking. Now, a psychogenic seizure is
different in that it does not have the electrical
storm associated with it. But physically,
it can look rather similar to an epileptic
seizure and can take some work to diagnose which is which. Let me show you
each– one of each. And you can see that there’s
some similarity to them. I’ve got permission to
show these seizures, but I’d rather anonymize them
anyway, cutting off the head. Well, I didn’t really
cut off the head– just photographically. So you can see this is
an epileptic seizure. And it’s in the
tonic-stiffening stage. At this point, the person
would be unconscious. And even though they
might be making a cry if we had the
audio with it, it’s because of the expelled air
against the closed throat. We think it’s not
because of pain. And now it is in the
clonic jerking phase. These seizures go on for
typically a minute or two minutes, and then the person
slowly wakes up, usually not remembering any of it. This is a nonepileptic seizure. And experts might
be able to tell them apart due to the
asynchronous movement of the limbs or the
type of movements. But it can be pretty hard. You can see that there’s a fair
amount of shaking and movements that occurs with
either of these. Now, in the case of the
nonepileptic seizure, the brain wave
activity– and this is 10 seconds of brain
waves from different parts of the head, called an EEG. The brainwave activity is nice
and low voltage and regular, and there’s even
something called– what looks like a sine
wave, for you engineers– a 10 per second
alpha rhythm, which is the brain’s healthy idling
rhythm in the brain, which you would never see during
a generalized tonic-clonic seizure. And here is a
tonic-clonic seizure. And the amplification
here is turned down, so that really this
is twice as big as it looks compared to this. But you can see the high voltage
rhythmical and synchronization across the head activities. So we can tell an epileptic
from a nonepileptic seizure from the EEG if we
happen to record it, say, in an epilepsy-monitoring
unit during the event. In other cases, we have to
use other clinical factors for the two of them. Does that to answer your
question, Dr. Karasov? That does. Thank you very much. And Dr. Fisher, are
there are some conditions that imitate epileptic seizures
but are not epileptic seizures? That too is a very
good question. And there are many of them. One of the most common would
be a fainting-type event, which is called syncopy
in medical terminology. There also can be sleep
disorders– people who fall asleep inappropriately. Perhaps they have narcolepsy. Perhaps the neurosurgery
or psychiatry interns– and they’re up all night. And these get confused
with seizures. People who have severe
migraines can sometimes become confused, even without
a very large headache. And those are particularly
hard to diagnose, if there’s a fluctuation
from migraines. Hypoglycemia and other metabolic
conditions can cause seizures. And there’s a whole
checklist of imitators of seizures on a medical basis. Then aside from the medical
imitators of epilepsy, there are the
psychiatric imitators of epilepsy, which
you’ll be hearing much more about from my
colleagues later in the talk. Perhaps we can turn the
microphone over to Dr. Kanner. And Dr. Kanner, what are
the psychological imitators of seizures? So among the more frequent type
of imitators are panic attacks. Very often in the course
of a panic attack, an individual may
perceive that they may become somewhat
confused in their thinking as they hyperventilate
very strongly. And these can be interpreted
by the emergency room physician as, oh, you probably had loss of
awareness of your surrounding, your probably had
a focal seizure. Nightmares, night
terrors, often can be associated with a diagnosis
or a misdiagnosis of epilepsy. Then you have, not
infrequently, individuals who have a condition known
as intermittent explosive disorder. This is a condition
where individuals start becoming increasingly agitated. And it can increase in
intensity to the point where they become violent. And at the end, they
have no recollection of what transpired. And that lack of
recollection– it’s often interpreted as
a possible seizure. And we often will
see these patients in the epilepsy
clinics for evaluation for seizure disorders. Interestingly
enough, individuals with intermittent
explosive disorders will improve with
antiepileptic medication of the type of the
antiepileptic drugs that have mood-stabilizing
properties, such as Carbamazepine. And so that further
enhances the confusion. And then you have individuals
with autistic spectrum disorder that have a lot of mannerisms. And as part of their mannerism
and behavioral patterns, they may often be confused
as epileptic seizures. And as Dr. Fisher
mentioned, the best way in kiddies with autistic
spectrum disorder of distinguishing whether
these are seizures or not is by doing a BDG
monitoring study. Thank you very much. I’ll turn the next
question to Dr. Barry. And Dr. Barry, why
do people have PNES? That’s another good question. The answer, however, I think
is hard for us really to know. We understand a lot
of the phenomenology of these particular events. The etiology of the
events, however, is really unclear to us. We have ideas. And the ideas basically
come from the ways in which these episodes
actually present and the context in
which they present. So if you ask why, it
may be a manifestation of severe depression. We consider this really a
communications dysfunction. And we can go in and talk a
little bit more about this. But the way we consider
this is many of these people have severe anxiety disorders,
as Andy was just talking about. They also have episodes of PTSD,
post-traumatic stress disorder. Many of these folks
have been injured as a child in a variety of
different unfortunate ways, which has resulted in them
developing a communication deficit. In 1975, Peter
Sifneos, actually, from Massachusetts, talked about
a disorder called alexithymia. And the Greek basically
means something for which they have no words. And many of these people
suffer from alexithymia. You have to remember
that when you were all kids, and your
parents– when you were growing up and you had
something happen to you, your parents would
label that for you. In situations, however,
where the parental situation is nonfunctional, people
develop a way of communicating. And the way they
communicate is somatically, by physical
manifestations rather than being able to label
emotional situations. So that’s a long answer
to your question. We also are starting
to look, actually, at some of the neurologic,
anatomic underpinnings. The diagnosis actually
of PNES really has changed in some
ways– at least the nomenclature in the DSM-5. Now these are called
functional neurologic disorder. And I actually really like that
terminology, because that’s kind of what it is. It’s a functional disorder. And I like it when I present
the diagnosis to patients too, because many times these
folks have been picked up by EMT or doctors in
the emergency room, and you would never expect
anybody to say anything to them– like you’re
faking it, or this is not real, or whatever, that
anybody would actually say that to an individual. But they do. And what we’re
understanding now is that this is a functional,
anatomic, physiologic process. So we have a lot
to understand more about this particular disorder. But that’s kind of a long
answer to your question. I see that Dr. Fisher
has something to add. John, we often treat the
same patients together– me from the neurological
and you from the psychiatric standpoint. A lot of the ones
I’ve seen have either suffered some form of abuse
when they were younger or they’re in some situation
in which they can’t cope. And we use words here like
functional and conversion disorder. Could you say a little
bit about what those words mean in that sort of situation? Absolutely. It’s funny you
ask that question. [LAUGH] Conversion
disorders actually is a terminology that is really
ancient– ancient in the fact that it goes back to the 1800s. And it was a terminology
that was coined by Freud. And he basically was
talking about a conversion of an emotional conflict into
a physical somatic presentation which resolves that
particular conflict. I oftentimes use
the analogy of a boy getting angry at his
father, ready to hit him, and realizes that
he can’t do that, and developing a paralysis
of that particular arm. So he’s converting
basically the conflict into a physical
manifestation, and thus the terminology
conversion disorder. Most of the time,
it’s really hard. There may be aspects of
that in most situations. I don’t think that’s
necessarily true. But it’s a terminology
that’s been used in the past. And I like functional better. I think that that is more
apropos to many of the cases that we generally see. I just wanted to add
one other perspective. And first of all, the
psychogenic nonepileptic seizures have very
pleomorphic condition. So there are many causes. And there are a
certain percentage of patients who, when
you do an evaluation, you don’t identify at the
time of the evaluation any current psychopathology. And very often, just
by telling the patient, you don’t have epilepsy. These are not
epileptic seizures. You don’t need to
be on medication. The patient goes home
and the events stop. And so these are
individuals in whom probably whatever triggered the
events is not operant anymore. And what maintained the
persistence of this episodes was the fear of having epilepsy. And then you tell them, no,
you don’t have epilepsy, and it’s gone. So I think we have to also
keep that concept in mind, because very often
patients will tell you, but, doc, I’m not depressed. I’m not anxious. My life is going well. And we have to take him
at their face value. It’s not that they’re
trying to deny [INAUDIBLE]. Very often that can be
also [? annoying. ?] Whatever triggered it
was not operant anymore at the time of the evaluation. And if it’s
accumulated stress, it may not be stress of the
moment, of the attack. Right. Yeah. So that leads nicely
into my next question, which is for Dr. Barry. Is it current or past stress,
and if it is past stress, why would there be a delay? It’s actually both . So the way I, again,
look at it is, again, is a communication dysfunction. I think the thing that
Andy just mentioned, I think, also bears a
little bit of expansion. And that is, when a patient goes
to a unit like Andy’s or our’s here at Stanford, they’re
seeing a neurologist. The neurologist understands–
sits down, talks to them. They get their communication
message across. They’re listened to. Their appointments are made
for them for the future so they’re not abandoned. They’ll be
continuously followed. So when these
miraculously go away, they don’t miraculously go away. They go away because,
in many ways, the function of these
particular events actually has been fulfilled. So as far as past stress
or conflicts are concerned, past stress,
especially as a child, can cause permanent
neurologic damage. And so it’s important
to remember that. We’re learning much more
about that particular aspect of all this. I mean it affects
brain function, again, on a permanent basis. These are people
who have deficits that, because of their
particular backgrounds, will be with them forever. It doesn’t mean that
it’s insurmountable or that you can’t
treat it or they can’t learn alternate ways
of developing and dealing with issues and problems. But that Achilles
heel will remain in some particular capacity. Why does it happen now? There’s usually a
precipitating event, and it can be a variety
of different events. It may remind them
of a previous trauma. It may be, as Bob actually
was talking about, something that just overruns
any kind of coping strategies that they have, and
because of that, manifest in this particular fashion. The next questions
you’re going to ask– I’m going to usurp your
role here for a second. And that is I think these
are incredibly fascinating. I mean, when you look at
what Bob just showed you, and that this is a psychologic
phenomena that actually took place, I think that’s
really a fascinating phenomena. But the issue is that
somatoform disorders is what these used to be called. And somatoform disorders
are very common, and it’s not only in neurology. We can go through every
branch of medicine, actually, and each branch has their
aspect of psychological physical manifestations. You can do– certainly with GI. You talk about ulcers,
irritable bowel syndrome, cardiovascular disease,
dentistry, and TMJ. So we can go through. This is not an
uncommon phenomena. It may manifest differently in
different patient populations. And the next question
is, why does that happen? And I don’t know. I wish I did. But I think it’s fascinating. But it’s really
very, very common. And again, that difficulty
really expressing your emotions,
talking, communicating, and having it be a
somatic communication is the way this actually
happens frequently. Often times people
will say, I don’t know why it happens at night,
because I’m totally relaxed and rested at night. Why should that
actually take place? And the way I
generally understand is, you all remember when
you were back in Biology 304 and you had your
big exam– whatever. And you got through that
exam, and afterwards you thought you’d be feeling
fantastic, and you’re not. It’s after the emergency. You get yourself
through at all costs, but it’s after the emergency
is when things fall apart. There’s one other
observation I wanted to add to what
John said, and that is that in addition
to the events that you see happening with a patient–
headaches are very frequent. And I don’t know if you’ve
had that experience. But in experience,
a vast majority of patients with psychogenic
nonepileptic seizures report constant headaches–
and sometimes to the point where we have to refer them
to our headaches specialist, because they don’t respond
to pharmacotherapy. And so this is
just to illustrate the complexity of the problem. And let me expand on that. It’s not just headaches. It’s also pain in general. So pain disorders are extremely
frequent in this population. Just remember also that people
with depression– and many of these people have episodes
of major depression in the past or have a depression
at the present time. Somatic complaints and
pain disorders– I’m sorry? Mic further away. Further away? Is this good? Halfway. Halfway? Like that? OK. So pain is very, very frequent
in this patient population, too. So it’s not just headaches. And I think Andy’s
absolutely right. It’s frequently seen. But pain complaints of a
variety of different disorders are also very frequent. Think of things
like fibromyalgia, chronic fatigue syndrome–
those sort of things I think are also very common in
this patient population. I think all of your
comments nicely highlight the ways in
which the mind and the body are intertwined in
these disorders, and in somatoform
disorders in general. So thank you for that. Maybe we can turn the microphone
over to Dr. Kanner, then. Are these episodes in
a person’s control? So again, as I alluded before,
psychogenic nonepileptic seizures is a very
pleomorphic condition. And you do have a small
percentage of patients– and in my opinion,
it’s a small percentage of patients, who have what
we called malingering, which is a form of a
volitional movements or events that are
under their control. But in my experience,
it’s actually a very small
percentage of patients. And these are
people in whom there is a gain to be made from
having these episodes. I remember patients
who were suing somebody because of injury,
and they’ve developed these kinds of things. This is the kind of things. That I think the
majority of patients don’t have a conscious control. And I think this is a very
important concept that needs to be transmitted to the
patient and the family members, because it is one
of the big fears that patients experience–
that it s going to be thought that they’ve been making it up,
that they’ve been faking it, that they are doing it
to attract attention. And it’s one of the causes
that patients may react– why are you saying that? I’ve been told I have
epilepsy all these years. And I make it a point to
clarify not only to the patient but to the families that
this is not something that is being done volitionally. Whether the mechanisms
that are operant in causing these episodes– I think
it varies from one patient to another. And patients, over time, through
a variety of interventions and now cognitive
behavior therapy has been found to be an
effective treatment of helping patients to have less
of these episodes, or even stop having these
episodes, can, in a way, give the impression that
patients are under control. John used to– and you
still do– hypnosis in order to identify
triggers of these events. But in the majority,
this is not something that patients can
stop like that. I just want to second that. I used to run a group
here with patients with nonepileptic seizures. Ariela’s running one right now. And one of the messages at the
end of the group– everybody had all of their
events– actually, by the end of the group, which
actually was eight or nine months long, by the end of
the group, everybody had their seizures under control. They didn’t have any more of
their nonepileptic events. And they say, when you go
out and talk to people, ask them at the end–
what do you want me to do with this information? Well, publish it,
but go talk to people and tell them these
are not pseudo. They used to be
called pseudoseizures. Please tell them that
these are not pseudo. That has a very
pejorative quality to it– that we didn’t have
control of these events. We’ve identified
triggers and reasons why these things happen. We’ve been able to control it. We’ve learned about it. But we had no control of it. Please go tell people that
these were not pseudoseizures, that these are real events
that happened to me, and I had no control over it. I think that’s a very important
message, and one that’s important for patients
and their families to share and to educate
more of the population about this disorder. Dr. Fisher, I have
a question for you. How do you make a diagnosis
of nonepileptic seizures? We have marvelous technology
now in the neuroscience field. But the diagnosis of
seizures and epilepsy, which is the condition of
spontaneously recurring seizures, is still mostly
made by the history. That’s the first point. We take the description
of the events and we use our
experience to tell us, is it an alteration
of sensation, motor function,
behavior awareness, punched out in time, somewhat
stereotyped if it repeats. That sounds like an
epileptic seizure. Or does it sound like
somebody fainting when they stood up to suddenly? Or somebody falling
asleep who can be aroused? So we take the history. If Johnny has a, quote, seizure
every time Jimmy takes his toy, it’s probably not an
epileptic seizure. Because that’s not
historically consistent. It’s some type of behavioral
episode that’s occurring. So the most important thing is
to start with the description of the event. And we also look for
psychiatric factors. It used to be said
when I was in training that a psychiatric diagnosis
is a diagnosis of exclusion. You have to rule out
everything else first. Well, that’s not true anymore. There are criteria. There are things to look for
in a person’s background that are risk factors for psychogenic
nonepileptic seizures. We heard some of them. The only thing is
you can’t assume just because they’re there
that that’s what the answer is. You have to look farther
and you have to confirm it. We take a history. We do an exam to
see if there are any signs of neurological
damage that would go along with epileptic seizures. We run an EEG. An EEG is an
electroencephalogram. It’s brain waves. It shows the up
and down voltages across a person’s head,
because the brain is an electrochemical
organism, rather like a car battery for a Tesla– although a
bit more complicated than that. So with epileptic discharges,
we have that high voltage storm. But half of the
people with epilepsy will have what we call
spikes– abnormal surges of electrical activity
between seizures. So somebody has a
somewhat convincing story and has those spikes, then
I’m fairly convinced that’s likely to be seizures. These EEGs are normally
30-minute, one-hour affairs in the outpatient clinic. So we don’t usually capture
the seizure event itself. We’re looking for
these epileptic spikes between seizures. However, if it’s important
to capture an event, then we can do some type of
more prolonged monitoring. We can send people home
with an EEG headset for 24, 48 hours, that will
record it on a cartridge and look at all later,
when they bring it back in. They can push a
button if they had what they thought
was a seizure, and we can see what are their brain
waves doing at that time? And then the gold standard
test is the inpatient video EEG monitoring, and what’s often
called an EMU– not only an Australian bird,
but also standing for epilepsy monitoring unit. And in that circumstance, we may
withdraw medication– something that would not be
safe on the outside, but under direct
supervision it can be made safe– to
provoke the events, record the video, audio,
brainwave picture, and make a determination if
those are epileptic seizures. In some cases, despite our best
efforts, we still can’t tell, and then we may do what’s
called a therapeutic trial. We just made try some
anti-seizure medicines, if we think that’s
the avenue to try. Or we might try
anti-depression medications, if we think that’s the avenue. Or we might use medications
that might address both and see what happens. So it’s a process. One of the advantages
of practicing medicine in the 21st century
and having smart phone is that today we can
ask family members to take your smart phone
and videotape the event. Because that often can help
us capture the actual event. And while most of the time
if it a convulsive event you could reach a
conclusion of, yes, this doesn’t look like an
epileptic seizure. You have to also keep in
mind that certain events can have clinical
characteristics suggestive of psychogenic nonepileptic
events, and maybe clinical seizures. And the other
nonconvulsive events, where the individual
just sits there, stares, and is unresponsive, those are
more difficult to distinguish. But use the smart phone
today to capture the events. You bring it to the
consultation, to a physician. You’ll save a lot of money. To make this just a little
bit more complicated, people with epileptic events can
also have nonepileptic seizures as well. So maybe 10 to 15
plus percentage of patients with epilepsy can
also have nonepileptic events. So this becomes much
more complicated. It’s not an either/or
proposition, either. So you have to pay
attention to that. People with TBIs, for
example, have seizures, as Bob originally
talked about, as far as kind of overwhelming
your ability to cope. Certainly a lot of CNS
disorders can certainly overrun somebody’s
ability to cope and result in nonepileptic
seizures, but they also may have epilepsy too. So it makes it much
more complicated. I just wanted to illustrate
a point that has not been emphasized, and that is
that people can walk around with a diagnosis of
nonepileptic seizures for years. And one out of every
three to four patients that come to our epilepsy
monitoring unit– and not only ours in Miami,
but throughout the country and throughout the world–
don’t have epilepsy. And many of them
have been treated as if they suffered from
epilepsy for years and years. And so that’s
something that one has to always keep in mind
when evaluating patients with events. I’ve had several
patients referred to me for brain surgery to
cure their epilepsy who had psychogenic
nonepileptic seizures. We didn’t do the brain surgery. Dr. Fisher, maybe you
could say a little bit more about those patients who
have, as Dr. Barry brought up, both epileptic and
nonepileptic seizures, which certainly sounds like
a complex patient group. Yeah. That would be our most
complicated or complex patient group– people who have both. Even that group is
somewhat diverse, because you may
have someone who had epileptic seizures as a child. And then they may
have gone away, and now other events
are occurring. So we assume that
they must just be the adult manifestations of
those childhood epileptic seizures. But, in fact, these
new events are really something different, and
their psychogenic nonepileptic seizures. So that is one scenario. And that’s been fairly
common in my experience– almost as though the
brain has somehow learned how to have
epileptic seizures and is in that kind of groove so
that when other symptoms happen that convert from the
emotional to the physical, it takes that pathway. I speculate a bit on that. The hardest patients
of all are those who are having epileptic
seizures on Monday, and nonepileptic
seizures on Tuesday. The best way to
get a hold of those is to do the video
EEG monitoring and explore with the
patient and the family, what does this one
look like to you? How many of these do
yo u have at home? What brings these on? How about those? What brings those on? And in that circumstance where
they have both condition mixed, we clearly need to
use a dual approach– both anti-seizure medications
and psychiatric treatments that we haven’t talked
about yet, but we will– and take a very comprehensive
approach to the patient. But they can be very
difficult to treat. I think one group where
you may see a higher prevalence of both
epileptic seizures and nonepileptic
events are individuals with cognitive
developmental delay. And these are individuals who
start with epileptic seizures, and eventually they learn–
when I have my seizures, I don’t have to go
to workshop, or I don’t have to do this or that. And so it becomes like
a Pavlovian response. And again, it’s not
that they’re doing it– they’re faking it [INAUDIBLE]. It’s just a learned behavior. And they’re not doing
it to attract attention. In my experience, it’s more of
an avoidance-type of behavior. And some studies have
suggested that among people with nonepileptic seizures
that are cognitively impaired, 40% will also have epilepsy. So the morbidity is higher. It’s actually a good example. We’ll talk about treatments
in just a little bit. But whenever I see any
adult or child that comes in with a
developmental delay that we’re concerned
about the possibilities of these being nonepileptic
events, what I usually realize is that you have to sit down. You have to find out about
the system and what’s going on in the system. You have to do that generally,
but in this particular patient population in particular. Because what’s
happening is sometimes it’s a stress
response that there’s something going on in the
group home that’s problematic, or an individual
in the group home they’re having a lot
of difficulty with, or a romantic
breakup, or whatever. And it’ll be manifested
not in words, because words can’t be used
in this particular situation. It will be manifested
in behaviors. And so it’s actually
a good example of what happens in
people who do have cognitive abilities
of a normal range and also have verbal
abilities but I haven’t been able
to use them for one particular reason or another. It’s a similar
kind of situation. Along those lines, and thinking
about stress, Dr. Fisher, can stress provoke epileptic
seizures or just PNES? Clearly both. Surveys of people who have
ordinary epilepsy, not psychogenic nonepileptic
seizures, typically when asked will list stress as the
number one provoking factor for their seizures. There are many other
provoking factors– missing sleep, missing
medicines, physical illnesses. Some people may be provoked by
sugars or dietary indiscretions and alcohol and so on. But stress is often
listed as number one. But it isn’t a
one-to-one relationship. It’s not every moment
they get stressed they have an epileptic seizure. If that appears
to be the pattern, then I’m thinking it’s
probably not epileptic. And of course we’ve already
talked about the role of stress in PNES, psychogenic
nonepileptic seizures. It’s very major. But it’s often remote
stress– sometimes, perhaps, is it fair to say, with the
recent reminder at some level, maybe not an obvious,
but a subtle reminder, of that past stress. So stress is a common face
to both of those conditions. And Dr. Kanner, we know that
stress accompanies a variety of psychiatric conditions. Do other psychiatric
conditions tend to accompany PNES, or
psychogenic nonepileptic seizures? And if so, what should be done
for those comorbid psychiatric conditions? Yeah. So John already alluded to that. As I said, psychogenic
nonepileptic events is a very pleomorphic condition. And in many of these patients,
you will identify depression. And that long
history of depression is among the most frequent
comorbid conditions. Very often it’s not
only depression, it’s depression and
anxiety disorders. And you’re going to need
to treat those underlying conditions. So those are the most
frequent conditions. Post-traumatic stress disorder
is a big comorbid condition. And you can have,
associated with that, panic disorders that often
the panic attacks often gets misdiagnosed as
epileptic seizure. So you have all of that spectrum
of mood and anxiety disorders. Personality disorders
are not unusual in people with a long history of
psychogenic nonepileptic seizures. And this is also
seen in people who have been victims of
very traumatic lives throughout being victims of
severe abuse and neglect. Very often you identify
attention deficit disorder coupled with mood disorders,
and the combination of attention deficit
disorder and a mood disorder lead to these
personality disorders, when these people
grow up and they’ve been victims of
adversive situations in their life, particularly
abuse, it’s the perfect storm. And this makes treatment
of these patients quite challenging
for a psychiatrist, neuropsychologist, psychologist. And so you have to do a very,
very careful and detailed psychiatric history
in order to identify the psychiatric
comorbidities, as I said. Because essentially psychogenic
nonepileptic seizure is a neuropsychiatric disorder. And as John was saying,
it’s a condition where we are
starting to identify certain neurological
changes in the brain and neurochemical changes in
the brain with very strong psychiatric manifestations. But the treatment is a
psychiatric treatment. And that’s your target. You really have to do
a very careful history. Thank you. And Dr. Kanner? Yeah. How do you tell someone that
they don’t have epilepsy, but have PNES? So that is an
excellent question. And this is one of what I like
to call the art of medicine– when we present the diagnosis. You have to be extremely,
extremely careful how you present the diagnosis. Because it’s not as easy
as saying, great news. You don’t have epilepsy. You don’t have to take
all these medications. Bye. You know? Have a good life. It’s not as simple as that. Because what you’re doing in
many of these individuals is, you’re basically changing
their entire perception of their life. You’re taking away the
identity as somebody who has lived around their seizures. And all of a sudden,
you tell them, no, you don’t have epilepsy. The other– [INTERPOSING VOICES] [INAUDIBLE] replace that with. Yeah. So this is what I–
I’ll tell you what I do. First of all, I’ve
learned through the years that telling the patient you
have a psychogenic disorder, psychogenic seizure, very often
is encountered with a barrier. What do you mean psychogenic? What do you mean? Are you saying I’m crazy? Or are you saying
that I am faking it? And so the first thing I say
is, you don’t have epilepsy. Well, what is it, doc? Well, these are events that
mimic epileptic seizures. And this is the reason that
it mimics epileptic seizures. I show them the EEG recording
of a person with epilepsy. I show them their EEG. I say, you see? There aren’t these patterns. But what is it, doc? Well, these are
things that happen in people who’ve had a history
of anxiety, depression. We see it in individuals
who’ve been victims of traumatic experiences. We are seeing it now in
soldiers that are coming back from the war theaters. And it’s a way of their
brain to protect them from traumatic experiences. Does that sound like this
may be applying to you? And I let them see if they
can identify with this. Because that may be the most–
because if they’re telling me, oh, no. That doesn’t apply to me. What that tells me
is, doc, I’m not ready to hear that
this is psychogenic. And I can bang them
in the head all I want with telling them
this is psychological, and they’ll just build
a thicker barrier. So my approach in those
individuals is to say, OK. Well, I don’t know what
it is, what’s causing it. We can do a neuropsychological
and neuropsychiatric evaluation to identify. And then if they
say, oh, no, no, no. I don’t need that. That tells me even
further– I’m not ready to hear what
you’re trying to tell me. So what I do with those
patients is I say, OK. The most serious complication
is of you having these events, ending up in an emergency room. The doc in the
emergency room is not going to know that these
are nonepileptic seizures. And because these events often
mimic recurrent seizures– what we call status epilepticus. You can end up in an intensive
care unit, intubated, and doctors giving you
a lot of medication. So you need to avoid going
to the emergency room. I also explain these events are
not causing you brain damage. The electrical activity of
your brain is not affected. So this is in one
group of patients. My experience has been,
however, that people who’ve been victims of abuse
or traumatic experience are readily able to say, yeah. I was a victim of rape
when I was a child or when I was an adolescent,
or this happened to me. So a majority of patients–
if you present it in that way, will be able to tell you. And then you ask
them, well, do you remember what it
was like when you were being raped by so and so? And very often patients will
tell you, I don’t remember. My body was there,
but I wasn’t there. And that allows you to
make the connection. So just like your body
is protecting you, your mind is protecting
you from experiencing the traumatic
experience of the rape. Eventually this is a
mechanism of defense that your mind
uses to protect you from facing certain situations
that are uncomfortable. So it’s a– Finish your thought. Yeah. So you normalize it for
them so that it becomes an acceptable option, you see? But I think that the
big error that we make is going to a
patient and saying, oh, you have psychogenic events. Go to see a psychiatrist. Goodbye. Because then we’re
building up the barriers, and that results in a
more difficult referral to the treatment. I want to emphasize that for
any people who are listening . I’ve been doing this for 30
years, and it’s gotten better. But many neurologists just
have a terrible approach to psychogenic
nonepileptic seizures. You’re hearing from Dr.
Kanner and Dr. Barry how it should be approached. But the usual
approach that we see is what we called
diagnose and adios. The neurologist all of a sudden
says, this is psychiatric. It’s not my business. Goodbye. It’s just another form of
abandonment in their life. Whereas, this is a
neuropsychiatric condition, and it needs a joint
effort between neurologists and psychiatrists over the
long term to take care of it. You can see how we often
fail our patients who are really suffering. I also wonder,
are there patients for whom there is no
identifiable stressor or trauma but who have PNES? I’ll defer to Dr.
Kanner on that. Oh yes. As I was saying before,
we actually did a study a few years ago
where we actually tried to identify where the
predictors of, the cause of PNES after the diagnosis. And we found that about
20% of the patients, we couldn’t identify at
the time of evaluation any psychiatric conditions. Those patients did well
when they were discharged. They stopped having the events. We actually follow
the patients after. I am a strong
believer that you have to follow the patients,
for various reasons– first because you don’t
abandon the patient. Number two, because
you don’t know that these patients may not
have epileptic seizures as well. And when you’re taking
them off medication, boom. The seizures may come. Number three– because
very often they have other comorbid conditions,
mainly pain and headaches, for which the
psychiatrist may not feel as comfortable in handling. And so those are
the kind of patients in whom you don’t identify
the conditions where they stop having the event [INAUDIBLE]. And whatever it was that caused
the events in the beginning is not operant
anymore, and that’s it. For example, one of the
conditions that Dr. Fisher was alluding to– the
convulsive syncopy. It’s often misdiagnosed
as epilepsy. You tell somebody
you have epilepsy, you’re Messing up with
their lives big time. They can’t drive. They can’t do a lot
of these things. And so that in and
of itself can become a self-fulfilling prophecy
until you do the evaluation, and then that’s the end of it. So we should probably be a
little briefer with our answers so we leave time for
questions in the remainder. So just three more
remaining questions. We’ve talked a lot about
diagnosis and giving the diagnosis, and
touched a little bit on the role of
psychotherapy in treatment. But perhaps Dr.
Barry you could say some more about the general
treatment approach for PNES. So we just actually
finished a study. IT was a three-institute
study at Brown and at University in
Cincinnati looking at different approaches. Since the etiology of many of
these events are depression, we looked at the
treatment of depression alone with medication. We also looked at a group
of patients with CBT, which is cognitive behavioral
therapy, and a group that was treated with both, and then
a treatment as usual group, as Bob alluded to before. And actually, the
combined approach– which is always the case– with
CBT and medication did best. But there is a group
of patients who were treated with medication. And once their
depression gets better, many of these nonepileptic
events also get better. So cognitive behavioral
therapy is very useful. I use a psychodynamic
approach, because, again, as I’ve talked
about these, I think there’s a communication issue. And just as Andy
was talking about, with people who don’t have
a specific targeted stress or whatever that
caused these– again, they’re trying to communicate
in a schematic fashion. And if this can be
understood, these patients actually do very well. The patients who
do very well are those that have had the disorder
for the least amount of time– so in other words, patients
who have had them for less than a year or six months. There’s a high percentage
of those patients who actually will do well. And that’s one of the
reasons– and Bob alluded to this in the very beginning–
is that you try and get these patients in as soon
as possible before this gets to be a part of
their personality, the way that they
approach the world. Because then it becomes more
and more difficult actually to rectifying it. So the shorter duration of
time that this has actually been a problem– those patients
actually do quite well. And letting the patient
know that, I think, is actually very
critical too– that this is a treatable disorder. And Dr. Fisher, as a
neurologist who follows people with PNES in clinic, what is
your experience with prognosis? I think most of them
end up doing well. When I was starting
in this business, it was said that the
prognosis was something between poor and dismal. But that’s because
their doctors weren’t doing anything for them. They were just ignoring
or abandoning them. So now, if you take a joint
comprehensive approach and you try to address the
underlying causes for the PNES and you treat it, you treat
the depression if it’s there, you do cognitive behavioral
therapy if it applies, then the prognosis
can be pretty good. My experience is that
people vote with their feet. If they show up for
treatment, they get better. If they don’t show
up, for some reason, they don’t want to be treated,
and they will typically go on having the events. Can I just say a statement? I think one of things that when
you look at the three of us up here, we’re up
here for a reason. I’m a psychiatrist. And Andy is certified in both
psychiatry and neurology, and Bob obviously
is a neurologist. This is a very changing time. And that is, psychiatrists
and neurologists– the way I look at it, I’m very at
home working with Bob over in the unit more,
in many ways, than I am in the psychiatry unit. We work together. We work together all the time. And treating these
patients is very difficult. I think we’ve tried
to kind of get across the complexity of
these patients. Many is the time
that I see a patient and I don’t know what’s going
on, and I’ll give Bob a call and say, look. I’ve got this guy. Something’s going
on here, and I just don’t feel comfortable with it. Would you put him back in the
unit and evaluate him again? Because I’m just
not sure about this. You have to able to do that. And mind-body split,
the mind, like in psychiatry, and neurology–
that doesn’t exist anymore. There is no split. This is an organic problem. Descartes did us a
huge disfavor when he talked about mind and body. There’s all one–
it’s an organism. And this is a physical problem. So when we work
together like this, the probability of patients
getting better and getting good care is accentuated. I want to emphasize one thing. The presentation
of the diagnosis is pivotal in the patient
pursuing treatment. If you don’t present
the diagnosis properly, you’re going to make the
patient run away from your unit. [INAUDIBLE] Anyone who has this
problem, knows someone who has this problem,
and wants to get help, should go to a comprehensive
epilepsy center. It does take a
multi-disciplinary approach. It takes a place that can
do video EEG monitoring. If you don’t know
how to find one, look on epilepsy.com or the
Epilepsy Foundation website. Those are now conjoined
in the same organization for Find an Epilepsy Center. It’s not something that would
typically be best handled in your primary care
office, unless that person has an unusual skill
and experience set. Well, I think we ought to
close the questions down now from our moderator,
Ariela Karasov, and we ought to open
it to the audience. Would you moderate the
audience questions, as well? Does anyone have any questions? I’d be interested if
any of the speakers might talk to any significant
cross-cultural or sociological issues related to this disorder. So I live in Miami, which is a
city next to the United States. That’s not
cross-cultural anymore. [LAUGH] But it has very
rich cultural diversity. We have people from the
Caribbean, South America. A lot of Europeans and Asians
have also moved to Miami. And I have to tell you that you
see these kind of situations very frequently. In South America, you see it
with an increased frequency because there are certain
cultures in South America where incest is actually an
accepted– in quotes– an accepted practice. And so you will see it. I was born and raised in Mexico. In Mexico, we used to
see that very often when I was doing my internship in
the General Hospital of Mexico in Mexico City. And this was an expression
of a lot of forms of incest. And it’s not only something
that you see in Mexico. You see it in many countries
in South America, where these kind of practice stop. Dr. Fisher? In Arizona, where I practiced
for a number of years, we had the Native
American culture. And the Navajos have described
the hand-trembling attacks, which are highly correlated
with epileptic seizures, and the moth and
flame attacks, which is like a moth fluttering around
a flame, which they correlate with a nonepileptic seizure. So they use different words,
but different cultures see the same phenomenon. Other questions? So what percentage of the
population has this disorder? 5% of the world
will have a seizure in their life, maybe
more, especially if you count the febrile
seizures in children. Nobody knows really
what the subset is who have nonepileptic seizures. It is a small percentage of
people who have epilepsy. What number when you
come up with, gentlemen? With nonepileptic seizures? Nonepileptic seizures
versus epileptic seizures in a population. A study’s never been done. I think there was an estimate
of 0.4%. [INAUDIBLE]. [INTERPOSING VOICES] So that would be 4
out of 1,000 people with epilepsy would have
nonepileptic seizures. But if you go to
epilepsy centers, where there’s enrichment by
referral, as Dr. Kanner said, some places will have a third
to a half of the people referred for epilepsy turning out to
have nonepileptic seizures because the seizures
haven’t come under control with traditional medicines. One of the things
we haven’t said that should be mentioned briefly
is that some of the medicines work both for epileptic
and nonepileptic seizures. So a medicine like Lamotrigine,
which is a seizure medicine, is also a mood-stabilizing
medicine, and would help both. If you’re having complicated
migraines with confusion and you get put on Topiramate,
an anti-epileptic medication, it’s also an
anti-headache, a headache preventative medication. So sometimes we can be
clever and cover both bets. Other questions? Yeah. In terms of PNES, would
you be likely to see a wide variation of
presentation of the episodes, say, serial episodes? Sometimes yes and sometimes no. If we see a wide
variation, for me, it makes the diagnosis easier. Because seizures are relatively
stereotyped, one to another. So if the presentation depends
very much on the situation and is varied, I’m
inclined to think, hmm, maybe this is not an
epileptic seizure. But sometimes the PNES can
be very stereotyped as well, or they may have two different
types of PNES, each of which is stereotyped of its own way. How much time do we have? [INAUDIBLE] One more. OK. One more question. Yes. I have a question. I get the impression that
GPs can’t recognize this from what you’ve all
spoken about this evening. I live through this. I had uncontrolled
seizures for 22 years. And I got lucky one day. I was donating
blood at Welch Road, and I had a very minor seizure
while the IV was going in. The doctor on the
prem came in– OK. You’re going to the hospital
and having a CAT scan. I ended up being referred to a
great neurologist, [? Pam. ?] And then I was medicated, and
it wasn’t working after a while. And you, Dr. Fisher,
took care of me when I was in the
hospital having video EEG. And I had neurosurgery
seven years ago. Never had another seizure. But for years, 22
years, I’m having complex partial seizures. They’re getting worse and worse. But what’s frightening
is I’m driving around Woodside in Atherton with other
people’s children, plus my own, and it was really terrifying. I mean, my children still– if I
just make a sound on the phone. I had my first seizure
when my third-year-old was four months old. We were talking the other night. She heard me, [GASPS]. Mom! It’s just like a
trauma coming back. Because they remember me always
pulling over the car because in those days, I had an aura. So I could pull the car over
and wait for it to be over. But it’s really common that
these people don’t know what and they just say, OK. You’re having a panic attack. But it’s deadly, and I was
told by a neuroscientist at Cal that I probably have
lots of brain damage from 22 years of
having these seizures regularly, until they
became life-threatening and I ended up your care. Good to see you again. Yeah. [LAUGH] I really want to thank Dr.
Fisher, Dr. Kanner, and Dr. Barry for joining all of us,
and to thank the audience for being here tonight.

Comments (100)

  1. diagnosis of physical sezuris and they did the eeg scan on me and showed that it it's not in the brain and I'm still waiting for help and I need a therapist and idk if it's cause my hole life is was in special ed so idk if that has to do with it or when I hit my head but eeg showed no brain so I'm still having them and I hope I get help soon

  2. i got put in the hospital to be observed and have eeg hooked up to i had one of theses episodes while i was there and my can last for hours at time .no one knows what to tell me about this .i need help can someone please give me some insight. or at least a name to call this .

  3. could this be related to a nervous break down .

  4. Up to 5 years ago never had fit but since then had no end and they say they are stress related fits. Am really fed up with them never know when they going to get me wish they go away .

  5. Are seizures from ETOH withdrawals epileptic in nature?

  6. Is it common for people to visually hallucinate during one of these seizures? My granddaughter sees bugs once in a while , she is 5 yrs old.

  7. To me, Dr. Fisher is like the Jerry Garcia of all neurologists. And the Grateful Deads are my favorite band. Dr. Fisher knows a lot.

  8. We need to acknowledge the limitations of our current EEG technology. Currently we are only able to measure brain activity at the scalp. We do not yet have the ability to measure brain activity deep within the brain. I do not believe in pseudoseizures, psychogenic seizures, non-epileptic seizures, or whatever way they may wish to describe these. We may as well still be blaming seizures on demons with our defective reasoning.

  9. Please hear me out…do NOT let your doctor tell you that you are having 'pseudo seizures' and that they are triggered by underlying emotional trauma. Please read all of this because I know the trigger. Don't just take my word for it or call me crazy. Do your own research, then call me crazy. You'll never believe the trigger unless you compare YOUR OWN diary to this. I'll give you plenty of links. My story…

    For about 10 years or so I've kept a diary of symptoms/events which doctors are now calling 'pseudo seizures'. Mind you, I have already been diagnosed with epilepsy as well, even by their strict standards (EEG confirmed/EEG proof). I do not believe in pseudo seizures, psychogenic seizures, non-epileptic seizures (the expression of an underlying psychological condition), and as I stated below, foolishly, I believe doctors/researchers are NOT acknowledging the limitations of our current technology. EEGs today are only able to measure electrical activity at the scalp. We cannot yet measure activity deep within the brain. As a result, even a week in the hospital may not be long enough to pick up seizures or seizure potential even if you DO adhere to the standard of having 'EEG proof' of seizure activity to diagnose an individual with epilepsy. Basically I believe researchers are being foolish by blaming what they can't explain on some mental condition, some trauma-based issue that has not yet been dealt with.

    Okay, now as crazy as this sounds…and don't take my word for it!…keep a diary yourself and compare your 'pseudo seizures' to the following. I'll tell you what to look for as I've been keeping a diary for at least 10 years and comparing the 'timing' of events to…solar and geomagnetic activity. If you don't find a connection, you're welcome to call me crazy. Links:
    _

    Forecast Discussion (the most informative, complicated though if you're new to this):
    http://www.swpc.noaa.gov/products/forecast-discussion

    Just some abbreviations for you.

    CME = coronal mass ejection

    CH HSS = coronal hole high speed stream (of solar wind)

    CIR = co-rotatimg interactive region

    SSBC = solar sector boundary crossing.
    _

    Space Weather:
    http://www.spaceweather.com/
    _

    Today's Space Weather:
    http://legacy-www.swpc.noaa.gov/today.html

    This is going to look Chinese to you initially, but eventually, if you check it daily, you'll learn the 'norm'. (Be aware that sometimes geomagnetic events ARE in progress even when these graphs appear pretty 'normal'. Confusing, I know!) Keep in mind too that these graphs are in UTC (universal time), so you'll have to use a UTC converter. I live on the east coast, so if I check these graphs late, even though it's still Friday here, it's already Saturday morning on these graphs.

    PROTON FLUX (bottom graph):

    Check the bottom graph daily as they only give you 3 days worth at a time. A 'flat-line' PROTON FLUX is normal/quiet. If it begins to climb, that indicates a MAJOR increase in solar activity, usually because of very strong solar flares or other significant events. Sometimes there are 'full halo' or 'partial halo' coronal mass ejections too, triggered by solar flares, erupting filaments, or unstable prominences (they look like little flames protruding from the sun). Sunspots, if they don't decay, face earth for 2 weeks. (It takes about 27 days for the sun to make one rotation.) It's possible that if a sunspot hasn't decayed while facing away from earth, in 2 weeks we could have additional storms.

    ELECTRON FLUX (bottom graph):

    I used to have a bookmark which indicated what each color signified, but I lost it. One was speed, density… I forget the others and which was what. Look for sudden zig-zags (all colors). Look for 'tight' zig zags (any color). I was having a lot of seizures when the blue ELECTRON FLUX zig-zagged tightly (had my car accident). Tight red zig-zags cause me problems too (night sweats, gritting…) Everybody has different triggers.

    ESTIMATED KP (bottom graph):

    Look for yellow and red bars. The taller they are, the worse the geomagnetic storm. Obviously, red is stronger than yellow. Green is 'normal', BUT that doesn't always mean all is quiet. I'm still trying to figure out the GOES HP. Sometimes there are sudden dips…not sure what that means.
    ___

    Solar Region Summary:
    https://www.spaceweatherlive.com/en/…/sunspotreport

    I check this page basically to find out the number and complexity of the sunspots. Alpha & beta are normal and not too complex. If you see beta-gamma, beta-gamma-delta…these are very complex and unstable.
    ___

    Space Weather Prediction Center Current Conditions:
    http://www.swpc.noaa.gov/products/no…tions-timeline

    This is a good one. It tells you when there are X-ray events (X-flares & M-flares are very strong), radio events, sudden impulses, proton storms & geomagnetic storms and their severity. It even gives you 'watches'. If you scroll to the bottom, it'll give you the previous 7 days. The more colorful this is, the more worrisome. Just so you know, protons indicate a solar storm. Electrons indicate a geomagnetic storm. Protons are much larger/denser than electrons, but electrons are not by any means harmless.
    ___

    The Sun Giveth – The Sun Taketh Away
    https://neuroresearchproject.com/201…n-taketh-away/

    Interesting article. If you scroll, you'll find seizures have been linked to solar & geomagnetic activity.

  10. thank you for this video I have this problem. I was hit in the head on the frontal lobe and in the back at first the eeg was coming as a sezuire then they started coming normal. the big problem I have is that I black out for weeks when this happens my family says that I can't walk or talk and I start choking when they give me water. as for me I don't remember none of it . when i start getting better i have to learn to walk and talk again.where i live the doctors don't really know what's going on I'm so exhausted already. I have no control over this is could be watching tv or showering or cleaning and it comes from no where. I get really scared sometime. can I please get some advise or where can I go to get help I'm from tx

  11. "I like how you highlight how the mind and the body are connected, thank you."
    "Can a person control the episodes?"
    That's like asking if someone who gets migraines can choose to or not to have a migraine

  12. Omg anytime someone mentions Freud… I don't think ppl with a negative eeg means they have somataform. That's dangerous.

  13. This explains why my scans are all normal, and how I've "never had a true seizure" in my life!!! I learned more from this video than I did from my Neurologist.

    I have Gastroparesis. My episodes only happen when I haven't been able to keep anything (liquid or solid) down for a few days.

  14. thank you at last im not a liar

  15. This message is for Dr. Fisher, if he by by the luck of God sees it. I think I need your help. I've just been released from the hospital after spending about 5 days there (btw I live in IL) for having non epileptic seizures. I don't know what to do or have any direction. The neurologist in the hospital basically told me he does not know enough about this and to contact my psychiatrist. To let you know I have no crazy past events, so I don't know why I'm getting these. My biggest stress lately is lower back pain and raising 2 small children while trying to get by, lol. Yes, this is stressful and every mind is different, so this may be the root but doesn't seem to add up comparatively speaking. I do have generalized anxiety, as well as my husbans and my 4 year old. I also have a 2 year old on the opposite end. However, both my husband and my anxiety are controlled via klonipen and my 4 year old is in the process. I'm asking you for maybe a little understanding on this issue. My psychiatrist thinks more medical work up should be done, my internist's best answer was to admit me to a psychiatric clinic, and I have a neurology appointment next week. I can not control these seizes and they do not stop on there own. If I am capable of stopping them on my own I don't know how. Watching your videos and the knowing the results of my eeg, I am confident they are non epileptic. But why and how do I stop them. And is there any other medical reason to get non epileptic seizures, or is it always a psychiatric reason? Please help if you see this.

  16. @ Di Anne Foxx: This video was published in 2015! Agree use the IPhone video & show your physicians & ask for Neurological Consult!

  17. only religious people have this..because they live in a world of hoax

  18. See the problem is nobody follows up on these type of patients. They asked me didnit stop. I said yes. They said what changed I said I have a new job so I’m less stressed bc I’m not worrying. Fast forward a whole 6 months later. Me and my daughter was joking about something and that seizure thing came up. I said I guess it stopped since I moved and got a job. She tells me IT NEVER STOPPPED!!!!! I was floored. She said I see you when I’m you’re sleeping sometimes I sleep in the bed with you and you still do it. So I thought them telling me it’s not epileptic and changed my environment and it never stopped. I just don’t know they are happening

  19. Oh and my doctor prescribed volume I spazzed became violent bc of the volume ended in psyche. Than released and more seize and the ER doctor who diagnosed me calling it something else but calling it this in my medical records was rude, annoyed by me, never explained told me about follow up billed me $8,000 and put a levy in my name oh and he didn’t catch I was also precancerous 😡😡😡😡

  20. yes i like the scientific related discussion but all respect to these people they haven't a clue what we go through with these conditions.. i agree about the lack of interest from neuros and psychologists and even doctors and the your putting it on syndrome things need to be done not said….enough talking more actions please …we know what we go through …you are paid enough in your jobs now help us

  21. THANK YOU so very much! I’ve been diagnosed with “pseudo seizures” for 5 years. The only information I was ever given was that it was stress induced. This has helped me tremendously!

  22. I have this and I'm only 14. I have always been insecure and just never loved myself…some people say its fake Wich really is upsetting.

  23. I don't have any of this stuff but I do suffer from surgery induced hyper awareness muscle tension necessitating low-dose Valium. While no doc has ever labeled what I have as psychosomatic it has certainly felt that way. Looking at for from the Perspective of these doctors in this video makes me wonder if a change in vocabulary would dramatically help both the patient and provider. I literally get muscle spasms so strong that they affect my voic. All the best for everyone and their family suffering

  24. i don't know how or why this site showed up, considering it's it's been a few months since i looked up >>PNES, at the request of my brother, but it's what i hoped to find. I've been suffering from this problem with the use of Keppra(SP?), yet they haven't abated…..what organics can i use instead of BIG PHARMA pills. Please help?

  25. This was so informative. I have had this a long time, but didn't know exactly what it was called. I have seen a lot of people and have been in therapy. These seizures have not stopped in many years. I am learning to live with them. I was told my neurologist they were fake. I was told my psychiatrist they were real. I just want to live a normal life.

  26. Not all epileptic seizures show up on the eeg so they need to stop with that misinformation!

  27. Thw movie thelma brought me here bye:)

  28. I was dropped on a gravel driveway on my face at 6 weeks old, and I have eye seizures, no anxiety. I might have PTSD from other situations as a child as well..
    . Any idea what would cause that?

  29. I've been diagnosed with epilepsy possibly PNES. For a while now I've had seizures for over 10 years. A long time MRI couldn't show the signals and results from tests. But my neurologist have done far more intesives test and observations and believe PNES is what I have. Lost of memory, slow motor functions, slurred speech, agitation. Consyant over compulsions to do things several actions over and over. Wanting to block out the world and just go away. Ptsd from my childhood and military injuries. A double hit.

  30. I'm on kepra a medication before I was dilatium I thinks that was it called. I was under server abuse physical and mental from my father then i was able to join the Marines with medical appeal from naval doctors my mom got me to be seen and diagnosed for and with help able to join. Unfortunately it got far worse later in in life . I had to leave my career because it returned after being wounded badly. I've had it sinced 2005. I've had three grand mall attacks where like many of you in sure have had to be hospitalized. Full body and system shutdowns. Nearly died from a major attack in May of 2010.
    All this these doctors are saying makes complete sense and so much is on part what I've been through. For most of my life.

  31. I have epilepsy and just diagnosed with PNES. They started in April….it is now August. I've had custody of my 2 young grandsons since Jan 1st. They were abused..neglected…malnourished due to addiction in both parents. This has severely emotionally disturbed me from the start. I was at Drs almost every day…retraining them. Fast forward to August I am burnt out…overwhelmed….stressed out. I feel bad for my grandsons because my parents abandoned me so I know how they feel. Plus I have the worries of my son and daughter in law. I have severe anxiety disorder and depression too. My brain can't handle all of this stress….sadness…worry. I now have no energy and I am sleep deprived. I have a bad headache every morning and every afternoon. I j
    Have severe anxiety attacks at 3am and 1pm every day…exact time. I'm so exhausted that I can't sleep. I see a neurologist..psychiatrist..therapist..primary dr. My body has been extremely low….99/62. Normal for me is 117/75. My stomach is in a knot. Grandpa has had our grandson for the past 2 days. I told him I need 2 more days…I Need to relax and sleep. This is the worse thing I have ever experienced. I am on a high dosage of klonopin..Dilantin…gabapentin…citalopram…trazadone..and now seroquil to sleep, 50mg which doesn't work..message to psych ch dr. I've had epilepsy since age 6. My neuro was very thorough. Neuros today are a joke….no eeg….no bloodwork to determine level of Dilantin. M neuro yelled at me..and I had a seizure in his office. I believe patients are like cattle…we aren't listened to..no walking on tip toes..heels…hold out hands and close eyes. That is our problem. Neuros are getting kickbacks from pharma companies so they scribe those melds to get a kickback…more money in my pocket

  32. I thought they were panic attacks but they weren't. My Dr were i live now i explained what was going on she was the one who told i have seizures epilepsy. i wrote down what happened. My dad passed away 5yrs ago. It started happen then. The dr i had before she didn't believe me when i lived in the san Fernando valley ca. My husband has been there with me with my seizures epilepsy. I have bitten my tongue and i have swallowed my blood choking on my own blood. I'm 47 . My mom she was 14 when she had me she had gran mal seizures. I asked could i get i was told no. But apparently its hereditary. I'm on medication Keppra i have a had 2 seizures last month twice. I still don't understand. I have gran mal seizures.

  33. I was diagnosed with pesudo-seizures in 2016. The seizures started with muscle spasm like movements in my neck while I was still concussion and aware of my surroundings, able to talk and move on my own other than my neck. By the time I was diagnosed They had evolved into the "passing out" but being able to hear and feel what was going on around me, but not being able to see… and everything is still fuzzy, along with the muscle spasm like movements in my neck, these movements are only in the left side of my neck. I have had eegs, and went to a neurologist, and they agreed that it was not an epileptic seizure. I have had MRI's in the ER, and many more tests. These seizures have now recently evolved into the "passing out" and my awareness fading in and out meaning that I can remember only some of the seizure, fading in and out of being able to feel and hear what is around me. My right arm also has started to have spasm like movements in the muscles. From the time I started to "pass out" I will tense my entire body and curl inward. I have been gasping for air and screaming recently. I feel like they are just getting increasingly worse. I have been going to therapy and seeing a physiologist since I was 9 years old. I am now 18, these seizures have taken over my life. My first job I worked at waffle house full time, and went to high school full time, these stresses increased the amount of seizures and I went from working full time to 20 hours a week. I was living on my own so working on a servers pay only working 20 hours was not enough to live off of. I then found a job at a UPS store, I tested my boss from waffle house and told him I was just going to quit. This boss had already implied that I was faking my seizures and only had them to go home. he tested me back and said "thank you" and that was it. I got the job at the UPS store and the seizures continued to increase, and the boss there also implied that they were fake. I ended up quitting there also. i worked there for less than 90 days. In less than 90 days this boss told me that I was faking my condition and was not sure that he wanted to keep me as an employee because he cant tell if I will be reliable. I understand, yet the way he went about it was very unprofessional. I do not currently have a job because of these, and I am applying for disability. I am also diagnosed with PTSD, major depression, generalized anxiety disorder. These are the diagnoses that apply to what has been talked about in this video. The whole reason I commented is because I still don't feel like I have the answers that I need. The explanations that I have heard of what Psychogenic seizures are is that the patient is not aware during the episodes, Yet I am during the episode. I don't know where to go, or what to do with this. some of these seizures are triggered and others are not. If there is anyone who would like to help or talk feel free to ask for my email, or ask on this comment.

  34. I also wanted to add that I started taking medication at 9 years old, and at the beginning of this year I have stopped taking medication because none of it has worked for me. from 9 years old, to 18 years old I have had no medication significantly help my diagnoses (not including the seizures, nothing was prescribed for this specifically.)

  35. the most info i have gotten from professionals about this in the last 19 years…

  36. I need help with this. How? I live in Orange County, California.

  37. Thank you so much for your clear and careful explanations here with the videos and data to back things up. I had PNES 3 years ago, saw your videos and obtained excellent cognitive behavioral therapy with specialized trauma counselors. The PNES disappeared within a week. Jerking lingered longer, but also disappeared as the trauma work progressed. It has been described as the chronic alarm and cortisol state wearing out the nervous system by midlife. Another theory is that it is a delayed way the body somatically shakes out the stored energy of past chronic trauma which was suppressed in the mind to stay safe in youth. Conversion disorder is the term for that process, PTSD or CPTSD is the diagnosis, and CBT, journaling, self care, mindfulness and are the solutions. No epilepsy meds help it. Benadryl gives a temporary break, but is not a solution. Also, the permanent damage can be countermanded by the brainwork CBT develops new neural pathways that replace those undeveloped or overworked. 3 years later now, I live my life normally again. What lingers? An occasional sadness when reminded of the losses or hardships in childhood. Rarely a trigger will require me to ground myself and take a 20 minute break for deep breathing and self compassion; but that is not too difficult to manage – it's just unfair. But accepting the losses are vital to moving beyond the challenges. And for the record, the PNES causes exhaustion and muscle fatigue when severe, so rest is warranted. Nobody would want this to happen; it's a hard challenge to face, but there is help. Just get the right help; CBT

  38. This happened to me for 9months straight with no answers. I meditated and self medicated with CBD. 2 weeks after deciding I was done it all stopped. I feel it took some of my confidence but I'm seizure free. 2 years now.

  39. I remember a while after having a non epileptic seziour, I felt and saw many red bumps and bruises on my legs and arms. My friend told me a woman didn't believe my seziour and was pinching me repeatedly hoping I would react in some way.

  40. I’ve been having these for years but never told anyone because they didn’t fit what I knew to be a seizure. Only recently did I feel comfortable enough to tell my doctor.

  41. why did the er nurse say I was faking it because she said jerking my head had to be " vuluntary "….please message me on FB…..she left me feeling so traumatized,,,,and I was not feeling panic !!!

  42. the er told me I made it all up…the jerks were voluntary because she saw me jerk my head ?????……a communications disorder, PSTD, something for which you have no words, emotions turn into somatic reactions in physical, a functional disorder, (11:36) the ER will tell you you are faking it !! in a situation in which they can not cope !!!!! conversion disorder by Freud,,,,,,somatic / vs physical….converting conflict into a physical disorder is old termonlogy that may or may not be true,……I still have the damn fear ….but it has slowed and stopped on it's own…regardless of a trigger…it slowly had to fix itself…because Relplax was all I had to fix it…time can heal !…the neuro does not have TIME TO ANSWER ?s !!!!!!!!!!!! causing great stress and confusion and a real depression and despair….as I say despair and depression are not the same thing !…{{{{{{{{{{{{{{{{{over running any coping mechanism you have !!!!}}}}}}}}}}}}}}}}}}}}}……may manifest diff in diff patients….talking/ expressing….at night….a question….after the emergency is when you are ALLOWED to FALL APART……Hs !!!..pain disorders very frequent, somatic complaints, ( xxxxxxxx excuses like depression xxxxx, FM, CFIDS…mind/ body link…..) " LINGERING"……of events….small percent….no real gain from this……no conscious control ! (21:50) yet doctors tell family members they are making it up !!!!! causing more fear and helplessness in patient !!..varies from one patient to another !……[[[[[[[[[[[[[[[ told just need to relax, over and over and over and over >>> furious !]]]]…

  43. (26:28) psych reasons……need confirmed, was there neuro damage by high voltage storms…spikes between seizures ! look for spikes !

  44. what about the flashing lights, blurred vision, double vision, narcolepsy like tiredness, .falling, dizziness, nausea ect that stopped before anyone ran an EEG ?

  45. if no one will listen to me…why bother…is my current attitude it is useless to be taken seriously

  46. over running your ability to cope !!!…..can't assume it's horses and not a zebra !

  47. why did I get this now at age 48 ?

  48. is this a fancy occular migraine

  49. one doc said dopamine, the 2cd shook his head no…..skipping the restless leg meds ( dopamine treatment ) seemed to cause an attack

  50. why do doctors assume if they can not easily figure it out or put it under a microscope…its psych ? they just further aggravate the damn mental stigma that drowns your ass to begin with !

  51. I can't think straight, I can't remember, I can't take care of myself, no one listens, few care…..my checkbook is overwritten, I loose everything I touch, I forgot all I hear…yes I am stressed !!!!!!!

  52. then they tell me I am depressed, anxious paniced, need to relax…..no wonder I am a raging pit bull with such idiotic crap thrown at me daily !!!!

  53. yr 20018 and I am on my period and have extreme penis envy …and I wonder why my eyes roll and get stuck !……yes I believe this IS THE WHOLE TRIGGER !!!!!!……all patients are not idiots get it into your head !,,,,,all they need is the truth in a logical caring format !………

  54. if I am dumber every day..make more mistakes, remember less, get more confused, loose more things, get lost more……damn feels like brain damage to me idiot !…..if you woke up and you could not use your arms or legs would you not go to an ER ?……..

  55. ABANDONMENT !!!!!! congratulations !!!!!

  56. the doc said he could not treat a migraine with me having a mooooooooood…..my migraine did not get from a mood !!!!

  57. not able to trust any doc >>>>>>>>>>>>. hmmm panic…you win !

  58. go go magic prozac…….the whole damn world is depressed….good grief what did people do during the GREAT DEPRESSION ??????

  59. considering doctors do not treat "chronic problems "…..what does that tell me ?

  60. ABANDONMENT, IGNORING, BELITTLING, ……..reality check reality check reality check…if it works patients return period..or it's $

  61. organic, a large organism, getting GOOD care

  62. mulitdiscplinary approach !!! an epilepsy center….where was this info a month ago or 3 months ago ?

  63. they tell me I am depressed in the head..I just feel a huge pain in my ass from medical staff

  64. Navajo and hand jerks and moth and flame attacks(55:00)

  65. About 2 years ago i was going through a serious psychological trauma that left me in a catatonic state for around 30 hours, after a few months getting worse and worse i ended up having my first psycogenic seizure, i don't know how long it lasted (it felt like hours) but i waz paralysed and started seeing strange geometrical hallucinations appearing to be made of light, after that seizure i was calm and relaxed for the first time in years, since then i have had a few seizures per week but they are different, i usualy have enough warning to lie down on the floor or grab hold of something (my grip usual locks) although i have injured myself on a few occasions, then i have 2-5 minuits of uncontrollable twitching and shaking, if i am stood up i go dizzy, and afterwards i have problems remembering what i was doing before and am sometimes confused but not often, they are not painfull and i feel like i could snap myself out of it but i never seem to be able to make myself do so.
    Any info about treatments would be appreciate, i do have aspergers syndrome, borderline personality disorder, a.d.h.d., severe anxiety disorder, clinical depression and an i.q. of about 122 but i tend to be difficult to test due to my way of deconstructing the test questions. I am also taking an ssri called citrlopram for about 5 months now.

  66. Stress REALLY can be deadly 2 oneself

    and/or others.

    Anyone have information related to this topic causing car accidents?

  67. Hello,Dear Doctor Fisher and everyone.I have an epilepsy from childhood.I am 6.09.1985. In 2009 I had EEG and epilepsy monitoring , in right hemisphere was detected scare,it cause of deliverytrauma .I also have hemiparesis .When doctors detected it (EEG)they told that I have partial (focal epilepsy) after 8 years in summer 2017 I had EEG and monitoring again.Doctors told that I have psycogenic seizure .later they made diagnose conversive seizure(epileptic and non epileptic) .During seizures I am not always loose conciosnes.Eyes blinking, dominantly jarks and mooves left limbs and teeth jark. 1.5minutes. After a seizure I don't remember anything. It happens up to 4time per month, from 4 to 13 times per month.I have aura which mentiones that seizure comes. High blood pressure I have all the time before and during seizures. My question is, does normal EEG is always confirmation of non epileptic seizures?.Can Non epileptic fits look like epileptic fit?.My question is: is there any probability that epilepsy looks like no epilepsy?I have a stress some times but no any seizure.When I am happy and relaxed ,seizure can happen.It sounds funny but i try watch movie with horrible disaster senario in order to see will I have non epileptic fit or not,no seizures happen .Are there aby probability of couse non epileptic fits if hormone of stress and happiness disbalanced?As I said already it can happen when i happy or relaxed any time too .Main thing ,It happen most time in the evening.Doctors diagnoses me non epilepsy because EEG is normal and during seizure eye some time closed, sometimes eye blink.Is there any treatment for non epileptic seizure to not have them at all? Can epilepsy have normal EEG? I was wondering when doctors said me you have no epileptic fits. Then U was happy,I was thinking if i have no epilepsy ,psycogebic fit possible to treat an live will be ok.I hope i will get answer my questions)I apologise for annoyance.God bless you and your family

  68. I happened to me one. Once is enough bad enough. N very embarrassing.

  69. we help am suffering from seziures disorder may be before 3 year and am continue treatment but not effective me my condition and please dr to help me so am very thankful to u

  70. sign and symptoms confused irritating abnormal behaviour and igraine

  71. More doctors need to be educated and trained in their bed side manners when dealing with people diagnosed with PNES.

    I’ve been treated horribly by medical staff as if I can control these episodes. If I could I would not be having any at all, period! This is nothing anyone wants or desires. It’s embarrassing as heck when this happens in public out of nowhere.

  72. mine come from PTSD!! if that helps any..

  73. I listened to the whole thing to see if diet was mentioned at all. Nope. Convoluted discussion about how psychology and neurology are linked. No shit Sherlock! Listen in, a ketogenic low-carb or carnivorous diet works full stop end of.

  74. Can someone tell me what kind if eclipse i have. Before a seziure. I can see a colourful bright star or i can smell something dirty.

  75. I have grandmal seizures. And in the beginning when you said they are yelling but it's not painful is wrong for some. Before I go unconscious it hurt very very bad.

  76. How do you treat PNES?

  77. I would like to know .Is there any epileptic sizure which has not abnormal EEG waves?Is there any probability that EPILEPTIC SEIZURE can look like on NON EPILEPTIC SEIZURE ? Does person diagnosed PNES have seizures regularly or sometimes he or she might have no seizure some space of time.Eg. No seizure within a month or more or PNIES happen regularly every month? I hope I will get answer on my questions )All the best .God bless you

  78. My “Seizures” began when I was 35 right after me and me husband separated. Johns Hopkins completed brain surgery to remove the damaged portion of my brain since they studied my active seizures to see where they were coming from and found that the main/central portion of my brain is where the seizures were coming from. Because of that they could not touch it. My seizures are now absence seizures but weird. I feel crazy and my family think the same. The absence period last 10secs but then I get up, am active, cleaning my house talking, walking around but when it’s completed I do not remember one thing that happened. Is this Phycogenic? My normal dad to day memory is getting worse.

  79. Thank you for posting this!
    #PNES #DystonicStorms #FunctionalDystonia #ParoxysmalDystonia
    #DystoniaAwareness
    💙, #DystoniaWarrior

  80. My legs often jerk when I get too excited, so I looked it up, and this was the first result. Am I normal or is there something wrong with me?
    I’ve often noticed that when I get very excited, I start sometimes shouting out things randomly, and when I’m alone, that’s when the leg jerks come in. I know it”s not normal because my friends never do it. At least.. in front of me. Can someone please help?

  81. Thank you so much for sharing this insight. God bless you three for doing such great work and posting all this valuable information.

  82. I have Grand Mal seizures unfortunately. Shortly after having my 3rd seizure i received a call from my sister. She wanted to know everything about them. I told her everything that i remembered and what i had been told happened. All of the sudden she started having "seizures" too. Nothing shows up on any test they run on her. On my MRI they found spots on my brain that might be causing it. So my question for anyone still watching this video is this. How can you tell an obvious faker like my sister vs someone that is having a non-epileptic seizure?

  83. I was diagnosed with PNES,PTSD also Depression and Anxiety..a year ago. It’s been hard for me since the first time it happened I was in the hospital for a whole week I didn’t know who I was ,or who was my family I didn’t even know I was in the hospital for a week. It is hard for me and my husband also my family it was worst in the beginning but I still get the seizures and it last for a while then I feel a lot of pain in my head in my body plus I wake up confused don’t remember where I was or how I got there..it’s really not good…sometimes I feel my mind cloudy…when I have the PNES seizure I won’t be able to speak for like 3 hours…it’s very difficult in life having these seizures ,I am also going to a phycologist ..

    When I was seeing someone in the hospital that had a heart attack it was very stressful for me that I had a seizure and was taken by the nurse to the emergency room…and my husband told me that he heard that one of the doctor say stop the seizure your faking it…he was so mad but didn’t say anything but when he told me I was so mad ..this is something real ..I’m the one who is having all this si proms and seizures…to say that I am faking it..the pain, the confusion, the not talking this symptoms are real…so I’m glad they had notice that PNES seizures are real we can’t control it…so this is my story..I’m still struggling for a lot of stuff.so I hope other doctors see this and change there demeanor of people that have PNES.

  84. I've had seizures since 12 and now i am 34. Ive had my right frontal lobe removed but unfortunately it didnt cure me but it helped in my recovery afterwards and i suffer from tonic clonic as they are now called..so i really do not agree with everything they say

  85. I was just diagnosed with PNES. I had many strange symptoms in the weeks prior to my first seizure. I think because doctors cant find or see something on a chart or machine, they tell you that you need therapy. Not buying it.

  86. Myea, I had to diagnose myself and then come back to my neurologist. Not with the terminology, of course, but.. Damn them, why are they employed. Basically, he told me I had anxiety and was thinking about appointing me to a psychiatrist who said hey, I can getcha downers. I had to go home, think and observe myself, then come back and tell him, me, an uneducated noob to a medical professional: hey, I think my brain lacks stimuli so I have to produce it myself (move a part of my body all the time, otherwise -seizures) or it produces its own crap (all types of pseudo seizures during which Im conscious, ergo not epileptic or anything of the sort), and secondly, I'm not anxious and would like to decline any offer that involves downers, because i think stimulants would work, if anything. It worked. He went with ADHD but whatever, and I got ritalin. Controls the pseudo seizures very well. While not on ritalin, I just have to move all the time. End of story. The shitty thing is, i only learnt i was correct two years after. I didnt know this was a known thing. Good to know I was right and i suppose it has some connection to hormones or god knows, bad, however, is the fact that the patient needed to diagnose and evaluate his condition for a doc.

  87. I LOVE THIS VIDEO because every body thinks the ribbon is for cancer or something else I have been to a hospital 2 times for a week and I’m 11 diagnosed with it I think 9 and I take 8 pills a day when I say I have epilepsy to people they sometimes try to compare it to something or say nothing but I don’t care. I also kind of feel a little bit offended when somebody fakes having a seizure but then get over it. I have once been on a diet but it didn’t really work. One time I fell getting ready for school and knocked down my vanity and got bruises on my face/head.

  88. They keep talking about childhood trauma. Why not about veterans? My husband started out with shiver fits with a metal taste in his mouth. Usually proceeded by a rage fit or some kind of stress. Ten years of this and no one can tell us why.

  89. My fiancee has been having these episodes. It started when she was pregnant with our first child. She convulses uncontrollably and has had issues where she would lose memories temporarily. After watching this video I am convinced that she is suffering from PTSD caused by her miscarriage with her first husband. We went through all the usual steps. Being told that is isn't epilepsy. Being told that it was an allergic reaction to Cannabis. We actually heard the term pseudo seizure but then they did bothing to address it. We had our first child and he is happy and healthy. The episodes stopped not completely but they were minimal enough that she was able to stop them from happening when she felt one coming on. Now she is pregnant again and the episodes have returned. After watching only half of this video I questioned her about her feelings regarding the lose of her first child and big surprise she blames herself for his death. I am now doing all I can to try and convince her that her miscarriage while tragic was just something that happened and that in no way was it her fault.

    If anyone would like to talk about this please feel free to reach out to me on youtube or on kik jsmith206

  90. My Dr's just shove anti epileptic meds down me push me out the door and say see u in 6 months the meds never work so they switch… If we don't turn up its not cos we don't want to be treated its cos we're better off untreated!!!

  91. CANNABIS OIL WORKS ON SEIZURES..

  92. I was born and diagnosed with High Functioning Autism and 'develop-mental-delays' which had put me in unique social situations with extreme bullying throughout my education and recreational time as a child. Having reoccurring night-terrors every night, and developing other fears I had kept entirely to myself, in spite of years of child therapy.
    I had endured psychological and physical abuse from my siblings and people who I thought were my friends.
    Between the ages of 11 to 13, I was prescribed Risperdol for psychological reasons by my family doctor, which gave me gynecomastia which led to strange identity and social issues.
    As I met my teen years, I suffered morbid obesity that gave me sleep-apnea, which through the years was not treated with a cpap. On and off because of inconsistent weight loss suggested so, as well as socio-economic reasons, as was my clinical depression.
    When I graduated high school, I experimented with self-tested self-administered psychoactive substances such as 11-Hydroxy/Delta-9 Tetrahydrocannabinal/Cannabis, Lysergic Acid Diethylamide/Acid/LSD, 3-4 MethalynDioxyMethAmphetamine/MDMA/Molly/Jigs, Mitrogena Speciosa/Kratom, Dextromethorphan, 4-Acetoxy N,N Diemethyltriptamine/Shrooms, Alcohol, And Nicotine.
    Then I had my gynecomastia surgically removed.
    As I grew and learned how to support myself with a job and a car and a home I share with my family, I found a dealership in my town that was willing to educate and employ me with a job as a technician.
    It was the best job I ever had, had it for a year, this past year, actually.
    I've dropped street substance use since months before my employment there and bettered myself.
    One day, mid-autumn, I fell unconscious before preforming an inspection and tire rotation, I had been feeling oddly dizzy and disoriented that day, a new feeling I now live every day with.
    My parents were called and I was rushed to the hospital with no physical injuries.
    They couldn't come to a conclusion in the ER after two hours of various scans, and after a couple months of countless appointments with neurologists/brain science peeps lol, they had concluded through excessive EEG hours on film that I had developed, and of course been diagnosed with, Psychogenic NonEpileptic Seizure Disorder.
    I remain in my home, making music and working when I can. Recently, I've obtained Cognitive Therapy whose appointments happen every 4 months, proven not optimal. But the tools I've been given have served me very well.
    Today, this morning, I had one of my worst seizure yet. Then I minimized what I could through these exercises and administered Cannabidol/CBD and Delta-8/Delta-9/11-Hydroxy Tetrahydrocannabinal and just so happened to find this conference out of 'patient' desperation.
    Now, I was able to type and form this comment as if it was an important document.

    Wishing You All A Blessed Beautiful Day, And A Fruitful Life Full Of Problem-Solving.
    Thank You To These Gentlemen Here For Their Work, And A Personal Thank You To Alternative Medicine.

  93. No stress , alkaline water, hemp oil, ketogenic diet, veggie protein shakes .
    My life is back

  94. I have a quick question: Sometimes I get up normally and my body starts to convulse (shake) and I fall over. My vision is usually spotty, but there. My body also goes numb. Could that just be fainting or actual seizure? It happens every so often.

  95. I was one of the first here to be diagnosed with PNES about four years ago. At first I was thought to faking these which only intensified them

  96. I have them through fear, had them in primary school would lose consciousness. Now I'm old they happen when I'm nervous about some ones demeanour, but it is just a sudden feeling in my head then a mirage feeling in my eyes. Then head ache n tiredness. I need testing properly have never been allowed. I was diagnosed with autism and ptsd mentioned. I've always had an over reaction inside to everything I try to hide it always have. One was so bad that I felt like I'd had a small stroke every single thing on my left side tingled even the left side of my tongue. Doctor will not send me for tests because I have anxiety.

  97. So, are they saying, really, that they don't know, theirs no way of telling which is which, childhood trauma or physical reasons? That there is no reliable diagnosis? Then if not, its a bit wishy washy.

  98. I thank you for this. I wish i had doctor's that could explain this like y'all did. Does head shake and eye pain associated with PNES. I had PNES i guess before but now it's getting to be worse.

  99. God bless you all for the work you do in neurology and psychology <3 <3 Though I am in the process of being completely diagnosed … I personally feel that if I am diagnosed with epilepsy, then there is certainly an overlap with me. So far my case has been controllable with epilepsy medication. Since being on medication I have not experienced seizures again. But I have also made drastic DRASTIC changes to my life in a short amount of time: removing stresses in my life, removing the things that were causing me to have anxiety attacks. I aim to sleep at 9 pm, I do not eat after 7 pm, I have cut out coffee that was making me anxious, I joined yoga, I weight lift now, I changed my nutrition. I 100 percent feel I needed a dual approach with my treatment to make my life holistically better and never experience a seizure again. Just improving my life I just feel in my heart I will not experience a serial seizure episode ever again unless that perfect storm of stress, anxiety, fevers, lack of sleep, dehydration, lack of sodium, having my period, breastfeeding and low blood sugar all hit me again at the same time. Really crossing my fingers, my MRI and EEG results will come back in my favor to perhaps one day being off the medication. But who knows I just am putting complete trust in my doctors. Living life as normal and to full potential as I can <3

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