Psychogenic seizures which are sometimes mistaken for epilepsy are linked to feelings of anxiety, according to new research by clinical psychologists from the UK and US.
Researchers from the University of Lincoln, University of Nottingham, and University of Sheffield in the UK, along with the USs Arizona State University, ran questionnaires and computer tests to find out if a patient regularly avoids situations which might bring on anxiety.
The tests predicted correctly whether a patient had epilepsy or psychogenic nonepileptic seizures (seizures that can be brought on by threatening situations, sensations, emotions, thoughts, or memories, also known as PNESs) in 83% of cases. These seizures look superficially similar to epileptic fits, which are the result of abnormal brain activity.
The team has devised a new set of tests to determine whether there was a link between how people interpret and respond to anxiety, and incidents of psychogenic nonepileptic seizures.
“PNES can be a very disabling condition, and it is important that we understand the triggers so that we provide the correct care and treatment,” said lead researcher Dr Lian Dimaro. “This study was one of the first to bring modern psychological tools of investigation to this problem. The findings support the idea that increasing a person’s tolerance of unpleasant emotions and reducing avoidant behaviour may help with treatment, suggesting that patients could benefit from a range of therapies including acceptance and commitment therapy to help reduce the frequency of seizures, although more research is needed in this area."
The group of study participants was comprised of 30 adults with PNES, 25 with epilepsy, and 31 adults with no reported history of seizures who served as a control group.
In questionnaires, study participants answered questions aimed at establishing how much anxiety they suffered from, their awareness of their experiences, and if they would avoid situations which would make them feel anxious.
Following that, those in the study completed a computer task requiring quick responses to true or false statements. This was a test designed to gather information on immediate, or implicit, beliefs about anxiety.
Participants also answered questions about common physical complaints that may have no medical explanation, also called somatic symptoms. These can include things like gastrointestinal problems, tiredness and back pain.
The results, taken as a whole, suggest that including tests to determine levels of anxiety and avoidance behaviour may help health professionals make earlier diagnosis, and develop more effective intervention plans.
The study found that those with psychogenic nonepileptic seizures reported considerably more somatic symptoms than others in the study, as well as avoidance of situations which might make them anxious.
The group with PNES also scored significantly higher on a measure of how aware they were of their anxiety compared with the control group.
“Epileptic seizures are caused by abnormal electrical activity in the brain, while most PNESs are thought to be a consequence of complex psychological processes that manifest in physical attacks”, said Dr David Dawson, University of Lincoln Research Clinical Psychologist. “It is believed that people suffering with PNES may have difficulty actively engaging with anxiety – a coping style known as experiential avoidance. We wanted to examine whether it was possible to make a clear link between seizure frequency and how people experience and manage anxiety. Our study is another step in understanding PNES, which could ultimately lead to better treatment and therefore patient outcomes in the future."
Lian V. Dimaro, David L. Dawson, Nicole A. Roberts, Ian Brown, Nima G. Moghaddam, Markus Reuber.
Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety.
Epilepsy & Behavior, 2014; 33: 77 DOI:10.1016/j.yebeh.2014.02.016