Abstract

Non-epileptic seizures are paroxysmal events that mimic an epileptic seizure but do not involve abnormal, rhythmic discharges of cortical neurons. They are caused by either physiological or psychological conditions. The latter is discussed more fully in psychogenic non-epileptic seizures.

[Please could somebody add an actual description of what happens when somebody has a seizure or 'paroxysmal event'?!]

Diagnosis

A wide array of phenomena may resemble epileptic seizures, which may lead to people who do not have epilepsy being misdiagnosed. Indeed, a significant percentage of people initially diagnosed with epilepsy will later have this revised. In one study, the majority of children referred to a secondary clinic with "fits, faints and funny turns" did not have epilepsy, with syncope (fainting) as the most common alternative. In another study, 39% of children referred to a tertiary epilepsy centre did not have epilepsy, with staring episodes in mentally challenged children as the most common alternative. In adults, the figures are similar, with one study reporting a 26% rate of misdiagnosis.

Differentiation of a non-epileptic attack from an epileptic seizure includes the patient keeping their eyes closed and rarely causing themselves harm (both more common in non-epileptic attacks)

Terminology

The International League Against Epilepsy (ILAE) define an epileptic seizure as "a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain." Epileptic seizures can occur in someone who does not have epilepsy – as a consequence of head injury, drug overdose, toxins, eclampsia or febrile convulsions, for example.

Medically, when used on its own, the term seizure implies an epileptic seizure. The lay use of this word can also include sudden attacks of illness, loss of control, spasm or stroke. Where the physician is uncertain as to the diagnosis, the medical term paroxysmal event and the lay terms spells, funny turns or attacks may be used.

Causes

Possible causes include:

- Syncope (fainting)

- Reflex anoxic seizures

- Breath-holding spells of childhood

- Hypoglycaemia

- Cataplexy

- Hyperekplexia, also called startle syndrome

- Migraine

- Narcolepsy

- Non-epileptic myoclonus

- Opsoclonus

- Parasomnias, including night terrors

- Paroxysmal kinesigenic dyskinesia

- Repetitive or ritualistic behaviours

- Tics

- AADC Deficiency