Stress can cause seizures known as psychogenic nonepileptic seizures (PNES). PNES differ from neurological seizures with causes such as epilepsy. Learn about stress’s relationship to PNES, panic attacks, and more.
For most people, feelings of stress are short-lived. For some people, stress can become chronic and greatly affect their quality of life.
Stress can cause a wide range of physical and mental symptoms, which may include psychogenic nonepileptic seizures (PNES). PNES were previously known as pseudoseizures, but that term is now outdated.
In this article, we’ll explain what PNES are, how they differ from neurological seizures, and the connection between stress and PNES.
A seizure is a brief period of uncontrolled electrical activity in the brain. Seizures can provoke a wide variety of changes in the body.
The chronic condition epilepsy causes unpredictable, recurrent seizures.
Epileptic seizures can occur due to a variety of triggers, including increased stress and anxiety. However, the Epilepsy Foundation suggests that it’s hard to know exactly how often stress triggers seizures. This is because stress has different meanings for different people.
Stress and anxiety can also trigger PNES in people without epilepsy. PNES are physiologically different from the neurological seizures found in epilepsy.
PNES aren’t the same as neurological seizures that occur due to uncontrolled activity in the brain. Instead, PNES can be an extreme response to stress and anxiety. Doctors consider them psychiatric in nature.
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When certain emotions become overwhelming enough, the body may shut down as a defense mechanism. In some people, this can present as PNES.
PNES most often occur in people living with stress, anxiety, personality disorders, or other traumatic emotional conditions.
In addition, anxiety is common in people with PNES (and in people with stress).
Although PNES and neurological seizures may appear similar, there are some differences in symptoms between the two.
PNES symptoms that occur during other seizures
For example, PNES may feature some of the symptoms found in neurological seizures, such as:
- lowered awareness
- loss of body control
- flailing or thrashing
- head arching
- tongue biting
A distinguishing feature of PNES is that these symptoms tend to appear more gradually and last longer than in neurological seizures.
Symptoms unique to PNES
In addition to the symptoms above, PNES may also have symptoms that don’t traditionally occur in neurological seizures, such as:
- side-to-side head movements
- nonsynchronized body movements
- muscle contractions
- closed or fluttering eyes
- crying during the episode
- avoidant behaviors
- memory problems
Stress and mood changes
Stress affects everyone differently. In some cases, chronic stress can lead to rapid changes in your mood.
A 2017 literature review concluded that people who experience stress-induced rapid mood changes might be more likely to experience PNES that last over 12 hours.
If you experience both rapid mood changes and PNES, it’s important to mention these when talking with a healthcare professional. This could help them make your diagnosis more precise and prescribe tailored treatment.
Anxiety symptoms can sometimes manifest as a sudden, intense episode called a panic attack.
Panic attack symptoms mimic many of the symptoms you may feel when you’re anxious. You may also notice other severe symptoms, such as:
- feelings of panic or dread
- feelings of disconnection from yourself or reality
- difficulty breathing or swallowing
- sharp chest pains
- chills or hot flashes
- numbness or tingling in the extremities
Panic attacks aren’t a known cause of neurological seizures in people without epilepsy. However, there may be a correlation between panic attacks and PNES.
In one literature review from 2018, researchers analyzed 26 studies for a potential relationship between panic attacks, hyperventilation episodes, and PNES.
According to the results, between 17% and 83% of those who had PNES also reported having accompanying panic attacks. In addition, the researchers found that 30% of people with voluntarily induced hyperventilation also experienced PNES.
While these results seem to suggest that panic attacks and panic attack symptoms may be a trigger for PNES, more research is still necessary.
Panic attacks and PNES can both happen as a result of stress and anxiety. There are differences between the two experiences that distinguish them from each other, though.
Panic attacks feature many, if not all, of the characteristic symptoms of anxiety.
Panic attacks come on suddenly and usually pass within 10 minutes. Many people who have them are still able to retain some level of function during the attack. The severity of symptoms can vary from person to person.
Many people who have PNES also experience panic symptoms, but some don’t. Episodes of PNES may not feature any symptoms of panic or anxiety at all. PNES also tend to come on gradually and last longer than panic attacks.
In some cases, panic attacks can even help a doctor differentiate between PNES and neurological seizures. In a
If you’ve been experiencing PNES, a doctor will most likely refer you to an inpatient setting for testing.
The following tests are important for building a full picture of why PNES are happening:
- Video-electroencephalography (vEEG): During your hospital stay, a doctor will connect you to an electroencephalography (EEG) machine and a video monitoring system. The EEG machine tracks electrical activity in the brain, while the video monitoring system records any physical symptoms. vEEG is the most common diagnostic test for PNES.
- Seizure analysis: To determine the correct diagnosis, a healthcare professional may analyze any seizures that happen during your stay. If you appear to have a seizure but there’s no unusual brain activity, the most likely diagnosis is PNES.
- CT or MRI imaging: Your doctor may need to request further imaging of the brain with a CT scan or an MRI. They may also want to rule out any other underlying conditions, such as nutrient deficiency or infection.
- Psychological testing: They may also recommend additional psychological testing to narrow down potential causes or triggers.
Since PNES are often psychological in nature, it’s important to address the underlying causes and triggers. Treatment options for stress-induced PNES may include:
- lifestyle changes
Cognitive behavioral therapy (CBT) is the first-line treatment for anxiety disorders. With CBT, you can learn how to better cope with stressful or anxious thoughts, feelings, and behaviors. This may help lower the frequency of your PNES.
In addition, trauma-focused therapy may be helpful for those who live with both trauma-based disorders and PNES.
Antiepileptic drugs aren’t effective for treating PNES, because the seizures aren’t neurological.
Instead, if you have anxiety, a healthcare professional may prescribe selective serotonin reuptake inhibitors (SSRIs) to help reduce the symptoms of anxiety and lower the number of PNES you have.
A 2017 literature review suggests that SSRIs may be most effective for anxiety when they’re used in conjunction with psychotherapy.
Lifestyle changes can also help to reduce the symptoms of stress and anxiety.
Focusing on the following can further lower your stress and anxiety and greatly improve your quality of life:
You and a doctor can work together to come up with the best treatment approach for your personal situation.
While stress and anxiety are unlikely to trigger neurological seizures in people without epilepsy, they can trigger PNES in individuals with underlying mental health conditions. Since these episodes have a psychiatric origin, addressing the underlying stress and anxiety can help reduce or eliminate these episodes.
If you’re concerned that you’ve been having PNES, reach out to a doctor for an appropriate diagnosis and treatment.