ANN ARBOR, MI - Emily Stevens* is afraid to do the ordinary things most of us take for granted. For years, she has been afraid to drive a car, be active in sports or even walk to the grocery store. Ever since Emily was diagnosed with epilepsy as a child, the constant threat of seizures - with loss of body control and consciousness - has made this 41-year-old woman a prisoner in her own home.

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As a child, Emily experienced sexual abuse and extreme emotional trauma. As an adult, she again became a victim, but this time of rape. To deal with the horror in her life, Emily learned a long time ago to keep her emotions and feelings to herself.

When even large doses of epilepsy medications couldn't stop all her seizures, Emily went to the University of Michigan Epilepsy Clinic. It was not long before Linda Selwa, M.D., medical director of the Adult Neurology Outpatient Clinic, discovered that Emily's problem was not only epilepsy, but a recently discovered condition called pseudoseizures.

"I was really upset when I found out it was pseudoseizures, because I felt like I was bringing it on myself," says Emily. "I would ask myself, 'how in the world could I do this to my own body?' Dr. Selwa, however, explained that it's not something I am doing on purpose, but something my body is doing as a release from stress."

Researchers at the U-M Epilepsy Clinic are experts in the diagnosis of pseudoseizures. "The vast majority of people diagnosed with epilepsy, do have epilepsy," says Selwa, a clinical associate professor of neurology in the U-M Medical School. "When seizures are prolonged or unusual in character, that should raise concern about whether patients have pseudoseizures, rather than epileptic seizures."

What are pseudoseizures?
Pseudoseizures resemble epileptic seizures. Patients experience episodes of loss of consciousness, twitching or jerking, and unusual emotional states, such as intense feelings of fear or deja vu. The episodes may last 20 minutes, but are not associated with electrical abnormalities in the brain as is the case with epileptic seizures.

Even for trained medical professionals, the differences between epileptic seizures and pseudoseizures are difficult to recognize. Physicians believe pseudoseizures are psychological defense mechanisms induced by stress or episodes of severe emotional trauma. The seizures happen when patients try to avoid or forget the trauma.

It's not at all uncommon that patients referred to an epilepsy center, after monitoring, turn out to have pseudoseizures. "The diagnosis of non-epileptic seizures really became common and better understood when we began to look carefully at people's brain electricity," says Selwa. "The earlier in the syndrome the patient is diagnosed, the better the chances for complete recovery."

How are pseudoseizures treated?
Diagnosing and treating this disorder is not easy. The diagnosis requires an inpatient admission where the patient is continuously monitored by both an electroencephalogram (EEG) and video camera. Both the EEG readings and tapes are scanned by medical professionals. After the seizure, the patient and family are questioned by U-M staff for level of awareness, memory and feelings during the seizure.

Upon diagnosis, patients receive an outline for treatment offered at the U-M Health System. This plan includes a discussion of the illness with the patient, termination of anticonvulsant medicines, which are sedating and worsen the problem, and counseling services. Many patients are also treated for depression or anxiety. This multidisciplinary approach helps patients resolve both the old and new stresses in their lives and a significant portion of the patient's symptoms can be eliminated.

What doctors need to understand is that those who suffer from pseudoseizures are not pretending. The seizures are real and dangerous and it is important to diagnose the disorder correctly, so the appropriate treatment can be offered, says Selwa.

"It's crucial that patients have a clear diagnosis. If there are questions about their epilepsy or why they aren't responding to medications, they should seek consultation in an epilepsy center," explains Selwa. "There, they can obtain a clearer, definitive answer regarding the nature of their episodes."

While seizures are still a part of Emily's life, she wakes up each day knowing that she is learning to control the episodes. "It is a relief to know there is something I can do about my seizures," she says. "In my case, it is talking and releasing and learning how to deal with stress in a different manner than holding it in. It's just like any other disease; you can do something to fix it."

Facts about Pseudoseizures:

• Pseudoseizures are not caused by an electrical disruption in the brain.
  
• Three percent of the United States population will experience a seizure at some point.

*Not her real name

For more information, visit the following Web sites:

U-M Health Topics A - Z: Seizures
http://www.med.umich.edu/1libr/aha/aha_seizure_crs.htm

U-M Epilepsy Clinic
http://www.med.umich.edu/epilepsy/

Epilepsy Foundation
http://www.epilepsyfoundation.org

Written by Rebekah Thompson

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