Non-epileptic attacks
are similar to epileptic seizures in appearance but do not
have the same characteristic changes in brain activity. As
with epileptic seizures, people may fall and injure themselves,
they may convulse and they may even be incontinent. Non- epileptic
attacks may occur for either physical or psychological reasons
and diagnosis is often difficult.
Who has non-epileptic
attacks?
As with epilepsy, any
male or female, of any age can experience a non-epileptic
attack. Research suggests, however, that it is most common
in women between the ages of 15 and 35. It is also possible
for someone who has epilepsy to also experience non- epileptic
attacks.
How are non-epileptic
attacks diagnosed?
The following investigations
can be used together to help a specialist make a diagnosis of
non-epileptic attack disorder:
1)
Observation
Much can be learnt
by observing a seizure and having a detailed description
of it. Medical staff may be interested to know for instance,
under what circumstances the attack took place, how
long it lasted, how long it took to recover and the
person's behaviour during and following the attack.
No single characteristic indicates that a seizure is
epileptic or non-epileptic and it is the overall pattern
of information which is of most help.
2)
Electroencephalogram
(EEG)
An EEG measures
the electrical activity from the surface of the brain.
A routine EEG recording takes approximately 30 minutes
and is completely painless. During an epileptic seizure,
characteristic EEG patterns are seen. In an non-epileptic
attack, these EEG patterns are absent. Having an attack
recorded on an EEG is therefore very helpful in making
a diagnosis.
3)
Video Telemetry
As observation
of seizures can be helpful in the diagnosis of both
epileptic and non-epileptic attacks, video telemetry
has been designed to enable a video recording to be
taken simultaneously with an EEG. Having video footage
of the attacks can often be helpful for the doctor.
4)
Blood Tests
Blood tests taken
about 20 minutes after some seizures (especially tonic
clonic seizures) normally show a dramatic increase in
the level of the hormone prolactin. If the attack were
non-epileptic no increase in the prolactin levels would
be seen.
5)
Personal History
A persons psychological,
social and medical history can also be helpful in identifying
factors associated with non-epileptic attack disorder.
Are all non-epileptic
attacks the same?
No, as with epileptic
seizures there are many different types of non-epileptic attacks
and they include:
1)
Panic attacks
Attacks can occur
in response to a frightening situation, and may resemble
epileptic seizures. Breathing difficulties, palpitations
and even loss of consciousness can be features of such
attacks. Over time, these attacks may occur independent
of the provoking situation.
2)
"Cut-off"
or avoidance attacks
This type of
attack may occur when an individual is unable to cope
with the emotional demands or stress of a situation.
As with panic attacks, over time this may happen in
situations which are not stressful. It is as though
the body has learned an unconscious habit from which
it can not break.
3)
Abreactive
attacks
This can occur as a delayed response to extreme stress
and may be part of Post Traumatic Stress Disorder.
Characteristics of these attacks may include crying,
screaming, and flashbacks. A person experiencing such
an attack will have no control over their behaviour
and may not remember the attack.
4)
Manipulative
attacks
These attacks may
occur in reaction to specific and unwanted situations,
and may be used as an attempt to control situations or
people.
What should I do
if someone has a non-epileptic attack?
In most cases a non-epileptic
attack should be treated the same as an epileptic seizure.
If a person is convulsing, then cushion the head and once
the attack, is over place them on their side in the recovery
position. During a non-convulsive seizure,
guide them away from danger and give reassurance when appropriate.
2004