From the Guidelines
Non-epileptic attacks and epilepsy are distinct conditions that require different treatment approaches, with non-epileptic attacks being best treated with psychological interventions and epilepsy typically managed with antiepileptic medications. The key difference in diagnosis is through video-EEG monitoring, which shows electrical brain abnormalities during epileptic seizures but normal patterns during non-epileptic attacks 1. Non-epileptic attacks, also called psychogenic non-epileptic seizures (PNES) or functional seizures, are episodes that resemble epileptic seizures but are not caused by abnormal electrical activity in the brain. Instead, they typically result from psychological factors such as stress, trauma, or emotional distress.
Treatment Approaches
- Epilepsy is typically managed with antiepileptic medications like levetiracetam (Keppra), carbamazepine (Tegretol), or lamotrigine (Lamictal) 1.
- Non-epileptic attacks are best treated with psychological interventions such as cognitive behavioral therapy, stress management techniques, and sometimes psychiatric medications if underlying conditions like anxiety or depression are present 1.
Importance of Accurate Diagnosis
Misdiagnosis is common and concerning, as treating non-epileptic attacks with antiepileptic drugs is ineffective and may cause unnecessary side effects. Accurate diagnosis is crucial for proper treatment and improved quality of life for patients experiencing either condition.
Diagnostic Tools
- Video-EEG monitoring is a key diagnostic tool for differentiating between non-epileptic attacks and epilepsy 1.
- Molecular neuroimaging using different radiopharmaceuticals with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) can also be useful in the diagnostic work-up and therapy management of epilepsy patients 1.
From the Research
Non-Epileptic Attacks vs Epilepsy
- Non-epileptic attacks, also known as non-epileptic seizure disorder (NEAD) or psychogenic non-epileptic seizures (PNES), are characterized by seizures that resemble epilepsy but lack physiological or electroencephalographic correlates 2.
- These seizures can occur in isolation or in combination with epileptic seizures, and their development and maintenance have been well-documented 2.
- The diagnosis of non-epileptic seizures can be reliably made by a trained neurologist/epileptologist using video EEG long-term monitoring in the seizure monitoring unit 3.
Treatment of Non-Epileptic Attacks
- Various treatment methodologies have been tried for non-epileptic seizures, including non-psychological and psychological therapies, with variable success 2.
- Cognitive behavioral therapy (CBT) has been shown to be effective in reducing the frequency of non-epileptic seizures and improving quality of life 2, 4.
- Other evidence-based psychotherapies for non-epileptic seizures include neurobehavioral therapy, which can be administered by a trained seizure counselor 3.
- Cognitive and behavioral interventions may be considered as low-risk adjuncts to standard therapies for epilepsy, with encouraging results found for CBT-based approaches and mindfulness or arousal-based programs 5.
Key Differences between Non-Epileptic Attacks and Epilepsy
- Non-epileptic seizures are often psychologically mediated, whereas epileptic seizures are caused by abnormal electrical activity in the brain 6.
- The diagnosis and treatment of non-epileptic seizures require a comprehensive approach, including neuropsychiatric and neuropsychological evaluations, and evidence-based psychotherapies 3, 4.
- While there is some overlap between the treatment of non-epileptic seizures and epilepsy, the two conditions require distinct approaches and therapies 2, 5.