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At present there is no real consensus amongst doctors about the most effective way to treat someone who has non-epileptic seizures. Sometimes (though not usually in specialist epilepsy units) a very confrontational approach is used: the ‘snap out of it and stop trying to pull the wool over our eyes’ school of treatment. This does not work because it blames the person for something which is not their fault and ignores the very important fact that all seizures, whether they are organic or emotional, have a cause. Above all, it does not take into account that these non-epileptic seizures can be just as disabling and disruptive for the patient as a ‘real’ seizure.
Treatment of non-epileptic seizures needs to be carried out in a specialist unit. The first step is to start investigating the seizures. The more thorough the investigation, the less easy it will be for the patient rationally to reject the suggestion that their seizures are not due to epilepsy.
At the same time the patient will be reassured that although the attacks are not epileptic but emotional, they are nonetheless real, and are due to a build-up of tension and emotion. They are also told that non-epileptic seizures need to be treated just as do epileptic ones. But the best news as far as the patient is concerned is that the seizures are more easily cured and the patient can learn to control their own attacks.
Each patient is given a key nurse to whom they can talk at any time. The relationship between the patient and the nursing and medical staff is crucial, because it is only when trust has built up between them that the patient will feel able to talk freely about the tensions in their life and the difficulties they are having, at work or at home.
RECOGNIZING TRIGGER SITUATIONS
The next step is for the patient to be shown how to analyse the situations in which they have attacks, and to recognize that there may sometimes be emotional triggers for their attacks. This is done in very much the same way that people who have epileptic seizures are taught to recognize situations which may trigger a seizure.
They will be taught to analyse exactly what is happening to them just before an attack starts, in particular asking
themselves:
What were they doing just before the attack?
How did they feel just before the attack?
What were they thinking just before the attack?
If they can recognize and record their emotions very precisely, they may be able to identify the thoughts that make them have an attack. Maybe they were feeling very tense; perhaps someone had been angry with them or spoken sharply to them and their feelings were hurt; or maybe some memory had come into their mind that was too painful to think about.
The patient is asked to think about the consequences of the attack too, and to note down in as much detail as possible not only what happened immediately after the attack, but how it may have altered the situation for them, and how they felt. If they were very tense beforehand, for example, did they feel much better after the attack? If they had been feeling very lonely or ignored beforehand, were people comforting them or paying them attention afterwards?
Usually, if they manage this sort of analysis honestly, most people can find some sort of connection between the likelihood of an attack occurring and their feelings, what is going on in their life or their relationships with other people.
BEHAVIOURAL PROGRAMMES
They will be taught to recognize situations in which they are likely to have an attack, but to try to talk about how they feel instead of allowing their feelings to precipitate an attack. They will be taught a method of relaxation, and shown how to use relaxation whenever they feel they might have an attack. They are encouraged to admit that their attacks are emotional and not epileptic. And they are helped to talk about their problems and anxieties rather than their seizures.
Finally, they have to be helped to come to terms with an absence of seizures and decide how they are going to run their life seizure free. The family is always involved in this phase of treatment, for they too will have to decide how they are going to respond to the patient’s absence of seizures.
The success of the treatment depends a great deal on how much the person still needs their seizures. The problems that created the need for seizures do not just disappear once the attacks stop, and they still somehow have to be resolved. The sufferer has to learn how to get his or her emotional needs met more straightforwardly, and the family have to be taught how to offer the support the patient needs. If these strategies can not be worked out, non-epileptic seizures are a problem that can persist.
Non-Epileptic Seizures: A Diagnosis Checklist
Do the seizures fail to respond to drugs?
Is consciousness maintained during a seizure?
Does the person seldom hurt themselves badly during a violent seizure?
Do they feel better after a seizure rather than worse?
Do their seizures last for a very long time?
Do their seizures involve very complex bodily movements, thrashing about or waving of limbs?
If the answers to all these questions are yes then it is possible that seizures are emotional and not epileptic in origin. At any rate, this is a possibility that the doctor will want to consider.
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