More info about Nonepileptic Behavioral Events in Kids
November is National Epilepsy Awareness Month. On this occasion my blog will focus more about epilepsy. In the 12th blog we see very interesting study for predicting our own seizures. Some persons with epilepsy can self-predict seizures. In these individuals, the odds of a seizure following a positive prediction are high.
In my current blog you will see in some kids we think they have epileptic seizures what they are actually nonepileptic behavioral events. In summary, nonepileptic behavioral events are not due to abnormal electrical brain activities despite the outward resemblance to seizures.
Nonepileptic behavioral
These events are attacks of falling and shaking, temporary loss of awareness, staring, or alteration in behavior that are often mistaken as seizures. Despite their resemblance, nonepileptic behavioral events and seizures stem from different causes. Seizures are due to abnormal electrical activities in the brain. In contrast, nonepileptic behavioral events are symptoms of a functional disorder in which no physiological or anatomical cause can be identified. Although the prevailing theory is that these symptoms arise from psychological stressors, the exact cause is unknown. Nonepileptic behavioral events are not purposefully produced. The symptoms are very real and not “faked.” The symptoms are present when the mind and the body for various reasons are not functioning properly. Terms used for nonepileptic behavioral events include “hysterical epilepsy,” “psychogenic seizures,” “pseudo epileptic seizures,” “pseudo seizures,” “non-physiologic or functional seizures” or “psychogenic nonepileptic seizures.” These terms carry negative connotations. The association with “seizure” adds confusion to whether the attacks are due to an electrical abnormality in the brain. This article uses the term ”nonepileptic behavioral events” and eliminates the use of “seizure” to discuss these attacks due to a psychological etiology.
Nonepileptic behavioral events are common and affect all age groups. About 20% of patients evaluated in adult epilepsy centers do not have seizures and have nonepileptic behavioral events. More adult women than men are affected. In children, between 3.5% and 7% of children seen in pediatric epilepsy centers do not have epilepsy and have nonepileptic behavioral events. Similar to adults, more teenage girls are affected than teenage boys. In school age children or younger, girls and boys are equally affected by nonepileptic behavioral events.
What do nonepileptic behavioral events look like?
Attacks of nonepileptic behaviors may include altered or loss of awareness, memory difficulty or loss, inability to speak, slurred or nonsensical speech, shaking in part or the whole body, and falls to the ground. Patients may report numbness, tingling, temperature changes, fatigue or weakness, dizziness, and vision changes. Unlike seizures, the symptoms of nonepileptic behavioral events frequently vary from one event to another. There is often a lack consistency in the symptoms seen within an individual patient. Nonepileptic behavioral events can be prolonged during which the symptoms start and stop. Nonepileptic behavioral events do not arise from sleep and may be intensified by the presence of an observer. Injuries are not different in nonepileptic behavioral events versus seizures. Injuries can occur in both nonepileptic behavioral events and seizures.
How are nonepileptic behavioral events diagnosed?
Nonepileptic behavioral events may be suspected based on the features of the attack, the patient’s clinical history, and the results of a physical exam. Making a confident and accurate diagnosis based on the description of witnesses or by observation alone may be challenging. Nonepileptic behavioral events can co-exist with seizures in individuals with epilepsy. About 10 to 15% of individuals with epilepsy have both nonepileptic behavioral events and seizures. On the other hand, seizures may be mistaken as psychiatric symptoms. Epilepsy and psychiatric illness frequently co-exists, which makes diagnosis challenging.
An electroencephalogram (EEG) measures the brain’s electrical activities. An EEG with simultaneous video monitoring is the standard used to distinguish nonepileptic behavioral events from seizures. A video EEG that records a typical event is the diagnostic gold standard to differentiate nonepileptic behavioral events from seizures. In some patients, symptoms need to be investigated for physiologic causes. These may include syncope due to heart issues, electrolyte imbalance, poor blood glucose control due to diabetes, gastroesophageal reflux, or sleep disorders. Other symptoms commonly seen in children that are not seizures include jitteriness, movement disorder, and self-stimulation. If an individual has both nonepileptic behavioral events and seizures, it is important to know which events are seizures and which ones are not so that both conditions are treated appropriately.
What causes nonepileptic behavioral events?
It is difficult to say with certainty what causes nonepileptic behavioral events for any one individual. However, the consensus from clinicians is that nonepileptic behavioral events are involuntary responses. In mental health circles, this is sometimes referred to as “conversion disorder,” with the implication being that psychological factors (e.g., anxiety, trauma, grief) are being involuntarily “converted” to physical symptoms. This does not mean that nonepileptic behavioral events are “fake” or a sign that someone is “crazy.” Nonepileptic behavioral events are not considered behaviors that individuals choose or plan – they become a pattern, almost like a reflexive response that the body has to certain triggers. Sometimes it can help to understand these triggers; but even without a complete understanding of the cause of the nonepileptic behavioral events, individuals can learn to change the way their bodies respond and break the pattern of nonepileptic behavioral events.
Anecdotally, many of the teens and children who have nonepileptic behavioral events are bright, sensitive, responsible, and somewhat perfectionistic individuals who are functioning effectively prior to the onset of the nonepileptic behavioral events. They may have less awareness of their experiences of stress or they may adopt more passive or avoidant means for coping with stress – seemingly, this leaves them more vulnerable to expression of this stress through physical channels. In some ways, the nonepileptic behavioral events may serve as a way to release stress or as a way of removing some demands that are hard to manage from individuals’ lives. What is difficult to explain is why the onset of nonepileptic behavioral events often don't coincide with the peak period of stress or why some individuals with temperaments that would seemingly leave them vulnerable to nonepileptic behavioral events never experience them. But, as stated previously, even without complete understanding of this, individuals can take advantage of treatments that have proven effective in reducing and eliminating nonepileptic behavioral events.
What is the treatment for nonepileptic behavioral events?
There is good evidence for the effectiveness of cognitive-behavioral therapy (CBT) in treating nonepileptic behavioral events in adults, as well as emerging evidence that CBT is also effective for children and teens with nonepileptic behavioral events. CBT involves increasing awareness of the inter-relatedness of feelings, thoughts, and behaviors and expanding the coping skills of individuals. This may include problem-solving around particularly important sources of stress (e.g., learning difficulties, bullying, family discord). It can also involve training individuals in strategies (e.g., relaxation, guided imagery) that allow them to have a greater capacity for physiologic self-regulation.
Perhaps the most important aspect of treatment is identifying behavioral approaches to minimizing the impact of the spells when they do occur. The goal is for individuals who are experiencing nonepileptic behavioral events to continue engaging in typical activities (e.g., school). Others who may be present when individuals have nonepileptic behavioral events are instructed to ensure the immediate safety of the individual, but to then remove all attention until the nonepileptic behavioral events have resolved. They then encourage the individual with nonepileptic behavioral events to return to typical activities as quickly as possible and maintain a focus on reinforcing adaptive coping behaviors from the individual. If consistently reinforced, these more adaptive and desired behaviors will eventually become the new “habit.” For school-age children, it is important for school personnel to understand conceptualizations of nonepileptic behavioral events. Written instructions from medical caregivers can be provided about how to implement appropriate behavioral plans in response to nonepileptic behavioral events in the school setting, rather than responding as if it were an emergent medical problem.
There is no clear evidence that medication directly helps with nonepileptic behavioral events. However, medications can sometimes be helpful in cases where individuals are struggling with clear anxiety, depression, ADHD, or post-traumatic stress symptoms in addition to the nonepileptic behavioral events. In summary, nonepileptic behavioral events are not due to abnormal electrical brain activities despite the outward resemblance to seizures. Nonepileptic behavioral events are common, affect all age groups, and are debilitating. Accurate diagnosis of nonepileptic behavioral events can avoid unnecessary testing, antiepileptic drug use, and further delay of effective treatment.
(Source-Epilepsy.com)
No comments:
Post a Comment