How To Differentiate Seizure And Pseudoseizure? Full Guide

18 Dec How To Differentiate Seizure And Pseudoseizure? Full Guide

Seizure is one of the most frightening things to witness: a sudden episode where someone loses control, shakes, or becomes completely unresponsive.

We immediately think “seizure.” But here’s the critical twist: not every event that looks like a seizure actually is one.

There’s a condition called a pseudoseizure (or PNES), which can mimic an epileptic seizure perfectly.

The difference is vital. An epileptic seizure is a brain short-circuit; a pseudoseizure is a physical manifestation of psychological distress.

Using the wrong treatment—like anti-seizure medication for PNES—is pointless and potentially dangerous.

Let’s break down the key differences between Seizure vs Pseudoseizure, so you know what you’re dealing with and can find the right help—especially with expert guidance from a trusted neuropsychiatrist in Patna Bihar, such as Dr. Vivek Pratap Singh at Pratap’s Neuro & Child Psychiatry Clinic.

What Are Seizures?

A seizure is a sudden, uncontrolled electrical disturbance in the brain, manifesting in various forms.

These disturbances can cause temporary changes in behavior, bodily movements, sensations, or consciousness.

Seizures are often associated with epilepsy, a neurological condition characterized by recurrent seizure activity, but they can also result from other causes.

Seizures vary significantly in intensity and duration. Some last only seconds, while others may persist for minutes.

Manifestations range from mild confusion to severe convulsions, depending on the affected brain area.

Causes

Seizures can be triggered by numerous factors. Identifying the underlying cause is crucial for effective management and treatment.

Common causes include:

• Epilepsy: The most frequent cause of recurrent seizures, characterized by abnormal electrical activity in the brain.
• Head Injury: Traumatic brain injuries can increase the likelihood of seizures.
• Infections: Conditions like meningitis or encephalitis can inflame the brain, disrupting normal electrical activity.
• Stroke: Reduced blood flow to the brain can damage specific areas, potentially leading to seizures.
• Heredity: A family history of epilepsy or neurological disorders increases seizure risk.
• Metabolic Disturbances: Conditions such as hypoglycemia, dehydration, or electrolyte imbalances can trigger seizures.
• Brain Tumors: Tumors can disrupt normal brain function, causing seizures.
• Drug and Alcohol Withdrawal: Abrupt cessation of certain substances can precipitate seizures.

Symptoms

Seizure symptoms depend on the type and the brain region affected. They can range from mild to severe.

Common symptoms include:

• Sudden, Uncontrolled Movements: Jerking or twitching of the arms, legs, or face.
• Loss of Consciousness: Temporary blackouts or unresponsiveness.
• Staring Spells: Brief episodes of blank staring, often unresponsive, common in children.
• Confusion: Disorientation or memory changes post-seizure.
• Muscle Stiffness or Weakness: Sudden stiffness or weakness, often causing falls.
• Breathing Problems: Shallow or paused breathing during a seizure.
• Cyanosis: Bluish skin due to oxygen deficiency in severe cases.

Other symptoms may include emotional changes (e.g., fear or anxiety), tingling, or visual disturbances.

Types of Seizures

Seizures are classified into two main types based on their origin in the brain:

1: Focal Seizures:

Originate in a specific brain area.

Subtypes include:

• Focal Aware Seizures: The person remains conscious, experiencing abnormal sensations like tingling, flashes, or auditory changes.
• Focal Impaired Awareness Seizures: Involve altered consciousness, confusion, repetitive movements, or unresponsiveness.

Symptoms may include involuntary jerks, sudden emotions, or localized sensations.

2: Generalized Seizures

Affect both brain hemispheres simultaneously, often causing unconsciousness and pronounced physical symptoms.

Types include:

• Absence Seizures: Brief lapses in consciousness, often seen as staring spells, primarily in children.
• Tonic-Clonic Seizures: Previously called grand mal seizures, these involve muscle stiffening (tonic phase) followed by rhythmic jerking (clonic phase).
• Myoclonic Seizures: Sudden, brief jerks or twitches, typically in the arms or legs.
• Atonic Seizures: Sudden loss of muscle tone, causing falls, also known as drop seizures.

What Are Pseudoseizures?

Pseudoseizures, or Psychogenic Non-Epileptic Seizures (PNES), are episodes that resemble epileptic seizures but lack abnormal brain electrical activity.

Unlike seizures caused by neurological conditions, pseudoseizures stem from psychological factors, often serving as a physical outlet for emotional or psychological distress.

Pseudoseizures are classified under conversion disorder, where psychological stress manifests as physical symptoms.

Diagnosis and treatment typically involve collaboration between neurologists and mental health professionals to address underlying causes.

Causes of Pseudoseizures

Pseudoseizures are rooted in emotional and psychological factors.

Common causes include:

• Previous Trauma or Abuse: Emotional distress from past trauma can trigger pseudoseizures as a response to overwhelming stress.
• Stress and Anxiety: Chronic stress or unresolved emotional conflicts may manifest as PNES, acting as a coping mechanism.
• Mental Health Disorders: Conditions like Post-Traumatic Stress Disorder (PTSD), depression, or personality disorders often co-occur with pseudoseizures.
• Emotional Suppression: Unprocessed traumatic memories or suppressed emotions can lead to physical symptoms like pseudoseizures.

The overlap of symptoms with epilepsy complicates diagnosis, requiring thorough medical and psychological evaluation.

Symptoms of Pseudoseizures

Pseudoseizures may mimic epileptic seizures but have distinct characteristics:

• Uncontrolled Tremors or Jerking: Rhythmic shaking resembling seizures, but brain activity remains normal.
• Sudden Drop Attacks: Loss of body control, often without injury, as patients may instinctively protect themselves during falls, a key indicator of pseudoseizures.
• Longer Duration: Pseudoseizures often last longer than epileptic seizures, sometimes exceeding five minutes, with variable duration.

Seizure And Pseudoseizure Difference

While seizures and pseudoseizures may appear similar, their causes, mechanisms, and treatments differ significantly:

Cause:

• Seizures: Result from abnormal brain electrical activity, often linked to epilepsy, brain injuries, strokes, or genetic factors.
• Pseudoseizures: Stem from psychological factors like trauma, stress, or mental health disorders (e.g., PTSD, depression).

Triggering Factors:

• Seizures: Triggered by physical factors like flashing lights, sleep deprivation, or fever.
• Pseudoseizures: Provoked by emotional distress, anxiety, or suppressed emotions.

Diagnosis:

• Seizures: Confirmed by abnormal EEG patterns and brain imaging.
• Pseudoseizures: Show normal EEG results, with diagnosis supported by psychological evaluation and video EEG monitoring.

Duration and Recovery:

• Seizures: Typically last 1–2 minutes, followed by a postictal state of confusion or disorientation.
• Pseudoseizures: Vary in duration, often longer, with rapid recovery and no postictal confusion.

Treatment:

• Seizures: Managed with antiepileptic drugs, surgery, or nerve stimulation.
• Pseudoseizures: Treated with psychotherapy (e.g., CBT), stress management, and medications for co-existing mental health conditions.

How Are Seizures and Pseudoseizures Diagnosed?

Diagnosing seizures and pseudoseizures is complex due to overlapping symptoms.

Seizures involve abnormal brain activity, while pseudoseizures are psychological in origin.

Neurologists and mental health professionals collaborate, using a range of tests to differentiate the conditions.

Medical Tests for Seizures and Pseudoseizures

1: EEG (Electroencephalogram):

Purpose: Records brain electrical activity via scalp electrodes.

• Seizure Diagnosis: Detects abnormal patterns during epileptic seizures.
• Pseudoseizure Diagnosis: Shows normal brain activity during episodes.

2: Video EEG Monitoring:

Purpose: Combines EEG with video to capture brain activity and physical symptoms simultaneously.

• Seizure Diagnosis: Confirms epileptic seizures with correlating abnormal brain activity.
• Pseudoseizure Diagnosis: Identifies pseudoseizures when no abnormal EEG activity occurs during an episode.

3: MRI or CT Scan:

Purpose: Provides detailed brain imaging.

• Seizure Diagnosis: Detects tumors, lesions, or structural abnormalities causing seizures.
• Pseudoseizure Diagnosis: Typically normal, as pseudoseizures lack structural brain causes.

4: Psychological Evaluation:

Purpose: Assesses emotional and mental health.

• Seizure Diagnosis: Identifies secondary emotional distress from epilepsy.
• Pseudoseizure Diagnosis: Uncovers psychological conditions (e.g., PTSD, anxiety) linked to PNES.

Seizure vs Pseudoseizure: Challenges in Diagnosis

The distinction between a true seizure (epileptic seizure, ES) and a pseudoseizure (now more accurately termed Psychogenic Nonepileptic Seizure or PNES) presents significant clinical challenges due to their often similar outward appearance.

A proper diagnosis is crucial because the treatments are drastically different: antiepileptic drugs for ES versus psychological therapies (like Cognitive Behavioral Therapy) for PNES.

Misdiagnosis can lead to unnecessary medication side effects, prolonged disability, and incorrect therapeutic interventions.

Here are the primary challenges in diagnosis:

1. Misdiagnosis: Pseudoseizures are often mistaken for epilepsy, leading to inappropriate antiepileptic drug use, delaying psychological treatment.
2. Similar Symptoms:Both conditions may involve convulsions or unresponsiveness, but pseudoseizures are triggered by emotional stress and lack postictal confusion.
3. Seizure vs Pseudoseizure symptoms-Based Diagnosis:Relying solely on symptoms can lead to errors; objective tools like EEG and video monitoring are essential.
4. Multidisciplinary Evaluation:Requires collaboration between neurologists, psychiatrists, and psychologists to address both neurological and psychological factors.

Seizures Treatment Options

Treatment is tailored based on whether the diagnosis is seizures or pseudoseizures, focusing on controlling symptoms and improving quality of life.

Therapies for Seizures

Seizure management involves medications, lifestyle changes, and, in some cases, surgical interventions to reduce frequency and severity.

Antiepileptic Drugs (AEDs):

• Commonly prescribed for epilepsy (e.g., carbamazepine, valproate, levetiracetam, phenytoin).
• Alter brain electrical activity to prevent seizures.
• Selection depends on seizure type, patient age, and health status.

Lifestyle Changes:

• Adequate sleep prevents seizure triggers.
• Stress management (e.g., meditation, yoga) and avoiding triggers like flashing lights or alcohol are recommended.
• A balanced diet and regular exercise support seizure control.

Surgery:

• Indicated when medications fail.
• Resective surgery removes the brain area causing seizures.
• Laser interstitial thermal therapy (LITT) is a minimally invasive option.

Vagus Nerve Stimulation (VNS):

• A device implanted under the skin delivers electrical impulses to the vagus nerve.
• Reduces seizure frequency and severity in drug-resistant epilepsy.

Pseudoseizure Treatment

Pseudoseizures are managed by mental health professionals, focusing on underlying psychological causes through therapy and stress management.

Psychotherapy:

• Cognitive Behavioral Therapy (CBT): Helps modify negative thought patterns and manage stress, anxiety, or depression.
• Trauma-Focused Therapy: Effective for unresolved trauma or PTSD, using techniques like Eye Movement Desensitization and Reprocessing (EMDR).

Medications:

Not used for pseudoseizures directly but may treat co-existing conditions like depression or anxiety (e.g., antidepressants, anti-anxiety medications).

Stress Management:

Techniques like mindfulness, yoga, and progressive muscle relaxation help regulate emotions and reduce triggers.

Support Groups:

Connect patients with others experiencing PNES, reducing isolation and providing emotional support.

Family Therapy:

Educates families about pseudoseizures, reducing stigma and improving support.

Addresses family dynamics to mitigate stressors.

Seizure vs Pseudoseizure Prolactin

Serum prolactin levels can serve as an adjunctive test to distinguish a true epileptic seizure from a pseudoseizure (psychogenic nonepileptic seizure or PNES).

• Epileptic Seizure (True Seizure): A significant and transient rise in serum prolactin often occurs following a generalized tonic-clonic or complex partial seizure. Blood should be drawn 10-20 minutes after the event for peak levels.
• Pseudoseizure (PNES): Prolactin levels typically do not rise significantly after a pseudoseizure, remaining near baseline.

Living with Pseudoseizures

Seizures whether it be non-epileptic or epileptic should be supervised under specialists.

Some people also come up with questions like Driving with Pseudoseizures. Basically, it depends upon the state laws and severity of your condition.

If you are experiencing any of the symptoms as listed above don’t compromise with it.

Mental Health is of the utmost importance and it needs critical care, awareness, and diagnosis by specialist.

If you , your kin or any of your friends are experiencing any symptoms of seizure and you are resident of North India or somewhere in Bihar, you might need to see neuropsychiatrist in Patna.

Let us make it easy for you. You can consult Dr.Vivek Pratap Singh who is listed as the best top neuropsychiatrist in Patna, Bihar for treating seizures.

He is a distinguished alumnus of the reputed WHO listed B P Koirala Institute of Health Sciences.

The psychiatrist also holds an MD in Psychiatry from D Y Patil Medical College and thus bring great acumen and knowledge of neuropsychiatry with him.

In addition, he has been an ex-resident at prestigious AIIMS Patna. Currently, he practises as Psychiatrist in PMCH Patna.

He also provides neuropsychiatric treatment at his clinic Pratap’s Neuro & Child Psychiatry Clinic, Patna, Bihar which specialises in treating neuropsychiatric illness, Dementia, Parkinson’s disease, Sleep disorders, psychotherapy, movement disorder, epilepsy, seizures and day-care deaddiction.

In conclusion, we hope this blog answered all your queries regarding seizures, difference Between Seizure And Pseudoseizure, Difference Between Epileptic Seizures And Pseudoseizures PPT, Pseudoseizure Icd-10 etc.

Post your further queries about difference Between Seizure and Pseudoseizure below in the comment section box.

FAQs

1: Are Pseudoseizures Real Seizures?

No, pseudoseizures (PNES) are not real epileptic seizures; they are paroxysmal events that look like epileptic seizures but are not caused by abnormal electrical activity in the brain.

They are, however, real medical events caused by psychological distress, stress, or underlying mental health issues.

2. How To Differentiate Seizure And Pseudoseizure?

Differentiation often requires a procedure called video-EEG monitoring, which records brain activity (EEG) and body movements simultaneously.

Epileptic seizures show specific abnormal electrical discharges on the EEG, while pseudoseizures (PNES) typically show a normal EEG during the event.

3: Are Pseudoseizures Fake?

No, pseudoseizures (PNES) are not considered “fake” as they are involuntary and genuine manifestations of psychological distress, not intentional malingering.

They are a real medical condition rooted in psychological mechanisms, such as conversion disorder, and are distressing to the person experiencing them.

4. Are PNES Seizures Dangerous?

PNES are generally not physically dangerous in the way epileptic seizures can be (e.g., causing falls or status epilepticus).

However, they carry significant risks related to misdiagnosis, which can lead to unnecessary and harmful anti-seizure medication, and the long-term impact of the underlying psychological condition on the person’s quality of life.

5: Are Stress Seizures Dangerous?

“Stress seizures” is another term often used for PNES (pseudoseizures), as stress and psychological factors are the root cause.

Like PNES, they are not physically dangerous but require treatment for the underlying psychological issues (like anxiety, trauma, or stress) to resolve the episodes and prevent long-term emotional harm.

6: What Does a Pseudoseizure Look Like?

For PNES (psychogenic nonepileptic seizures), the real game-changer is psychotherapy—especially Cognitive Behavioral Therapy (CBT).

Anti-seizure meds simply don’t help here.

CBT works by teaching you what’s really going on, spotting your stress triggers, and building practical ways to manage emotions and stay in control. The good news?

With the right support, 60–70% of adults and even more kids can become completely seizure-free.