Specialist epilepsy clinics treat a high proportion of people whose seizures haven't responded to anti-epilepsy drugs. It's estimated that up to a quarter of these people don't have in fact epilepsy at all, but psychogenic seizures instead.

"Psychogenic" means that these seizures have a psychological cause: they are a reaction to emotional trauma or excessive stress. The seizures are genuine and the person has no control over them. They can display typical features of epileptic seizures, for example auras, convulsions, and biting the inside of the mouth during the seizure. As a result they are often misdiagnosed as epilepsy.

Psychogenic non-epileptic seizures are treatable, but they do not respond to anti-epileptic drugs. There is no widely-accepted standard mode of treatment for them. Anti-anxiety medication and anti-depressants can help some people, otherwise "talking treatments" are generally favoured. Some people who have psychogenic seizures also have epilepsy, so treatment with anti-epileptic drugs may still be needed.

Treatment for psychogenic seizures
Doctors based at a specialist epilepsy clinic in Holland called Stichting Epilepsie Instellingen Nederland recently published their evaluation of a residential programme for treating psychogenic seizures. This was based on cognitive behaviour therapy, where a person explores with a therapist how they think about their seizures and the factors which affect how likely they are to have seizures, and aims to learn to control their seizures by thinking differently.

Twenty-two people with psychogenic seizures took part in the study. Six months after the end of treatment, 7 participants had become seizure-free, and another 6 had reduced their seizure frequency by more than 50%. Anxiety and depression rates fell in most participants. Becoming completely seizure-free led to the greatest improvements in quality of life scores, as might be expected.

This work is reported in the journal Seizure in April 2008. It's an example of what can be achieved in an intensive residential programme, delivered by a cross-disciplinary group of health professionals.

So what's normal treatment?
However for most people with psychogenic seizures, a residential programme won't necessarily be appropriate, or indeed available.

To find out how psychogenic seizures are typically treated in the US at the moment, Dr Carl LaFrance and his colleagues at Brown Medical School, Rhode Island, surveyed more than 300 epileptologists, neurologists, neuropsychiatrists, and nurses.

About 80% of survey participants recommended talking treatments as the most effective way of tackling psychogenic seizures, followed by education and then medication. A total of 83% of doctors reduced the dose of anti-epileptic drug to a person once their seizures had been diagnosed as non-epileptic.

Neurologists often referred the person with psychogenic seizures to a psychiatrist or a psychologist for their treatment, though generally continuing to follow their case. The study authors stressed how important it is that people with psychogenic episodes don't get lost in the health system between their neurologist and their psychiatrist. The results were published in February 2008 in Epilepsy & Behavior.
Read more about this study here

In contrast are the results of another US survey, this time of GP-level and A&E doctors, who are often the first to see a person who is experiencing seizures for the first time. Their attitudes and treatment decisions can have major implications, especially because rapid diagnosis of psychogenic seizures means a person has a better chance of becoming seizure-free.

The survey, carried out by Dr B Shneker and colleagues at Ohio State University, Columbus, Ohio, found that a significant number of these doctors believed that psychogenic seizures could be brought on voluntarily, and that interviewing the person for a history of symptoms was enough to diagnose non-epileptic events. In fact the gold standard of diagnosis used by neurologists is video-EEG.

The authors, writing in the April edition of Epilepsy & Behavior, call for better training on psychogenic seizures for these doctors.

What sorts of psychiatric condition can feature psychogenic non-epileptic seizures?
Dr RL Marchetti and colleagues from the University Medical Faculty Hospital of São Paulo, Brazil, looked at the psychiatric conditions underlying psychogenic seizures.

They used video-EEG to confirm the diagnosis of 28 people with suspected psychogenic seizures: 14 were confirmed with this diagnosis, 13 were found to have both non-epileptic seizures and epilepsy, and one had epilepsy only.

Twenty-three of the people with non-epileptic seizures had a type of somatoform disorder. These are conditions where a psychological need or pain is expressed in physical form, as a loss of function or as pain. Two patients had dissociative disorder, experiencing a profound dislocation between their sense of identity, current reality and sense of continuity. Two patients had post-traumatic stress disorder.

This article published in the April edition of Seizure shows that a number of different psychiatric disorders can produce seizure episodes.

Read more about psychogenic seizures here and here