Úvod - Epilepsie - Non-Epileptic Seizures

Non-Epileptic Seizures

Not every seizure-like event experienced by a patient is necessarily an epileptic seizure. There are several types of non-epileptic seizures that may closely resemble epileptic events but are caused by underlying conditions other than epilepsy. Although these episodes are not epileptic in nature, they can still significantly impact a patient’s daily life in a similar way.

Importantly, non-epileptic seizures do not respond to anti-seizure medications. Instead, successful management relies on identifying and addressing the underlying cause, often in collaboration with specialists from other medical fields.

Distinguishing between epileptic and non-epileptic seizures is essential for making an accurate diagnosis and choosing the correct treatment. Studies suggest that 20–30% of patients initially diagnosed and treated for epilepsy may not actually have the condition. The situation is further complicated by the fact that around 20% of people with epilepsy also experience non-epileptic seizures, most commonly psychogenic non-epileptic seizures (PNES).

Unlike epileptic seizures, non-epileptic seizures are not caused by abnormal electrical activity in the brain. During a non-epileptic event, EEG monitoring does not show ictal epileptiform patterns, which are characteristic of epileptic seizures.

There are many potential causes of non-epileptic seizures. These may be somatic (physical) or psychogenic (mental/emotional) in origin.

Physiologically (Somatically) Based Non-Epileptic Seizures

account for 10–15% of all paroxysmal (sudden-onset) events, with even higher prevalence in children.

These events can be caused by various medical conditions, such as:

  • Syncope (fainting): a sudden and brief loss of consciousness caused by insufficient blood flow to the brain, often due to a drop in blood pressure. It most commonly occurs while standing or upon standing up quickly. It is often preceded by symptoms such as weakness, nausea, paleness, heart palpitations, or ringing in the ears. Some syncopal episodes may be accompanied by convulsions (convulsive syncope), but these movements typically occur after the loss of consciousness and fall to the ground.
  • Cerebrovascular events (e.g., strokes)
  • Metabolic and endocrine disturbances
    (e.g., abnormally low or high blood sugar levels)
  • Seizures related to medication effects or intoxication
    (e.g., due to alcohol, recreational drugs, or sedatives)
  • Sleep-related paroxysmal disorders
    (e.g., sleepwalking or night terrors)
  • Paroxysmal movement disorders
    (e.g., tics or motor stereotypies)
  • Migraine-associated conditions

    (e.g., visual auras that may mimic seizure activity)
  • and other less common causes
Psychogenically Based Non-Epileptic Seizures

In children, non-epileptic episodes that mimic epileptic seizures may occur in specific contexts. For example, breath-holding spells (also known as affective respiratory spasms) can happen when a child becomes emotionally upset—crying is followed by a brief cessation of breathing during exhalation, sometimes leading to transient stiffness or loss of consciousness. Another example is reflex anoxic seizures, where a sudden, unpleasant stimulus triggers a short episode of unconsciousness with convulsive movements.

Panic attacks may also resemble epileptic auras, with symptoms such as sudden fear or a sense of doom, accompanied by hyperventilation, shortness of breath, palpitations, chest pain, and tingling or numbness (paresthesias).

The most common type of non-epileptic seizures are dissociative seizures, also referred to as psychogenic non-epileptic seizures (PNES). 

Epilepsy