1. epilepsy
Explaining seizures that are not epileptic
non-epileptic seizures

2. A large print text only version of
this leaflet is available from the
Epilepsy Helpline on:
01494 601 400
(Monday - Friday 10am - 4pm)
non-epileptic seizures
Contents
1 Introduction page 3
2 Causes and diagnosis page 6
3 Dissociative seizures (DS) page 11
4 Treating DS page 15
5 Living with DS page 17

3. Explaining seizures that are not
epileptic
You may have picked up this leaflet because
you, or someone you know, have just been
diagnosed with non-epileptic seizures.
Non-epileptic seizures (NES) often look like
epileptic seizures but they have a different
cause.
In this leaflet we look at the different types
of NES, why they happen, and how they are
treated.
1. Introduction
Are all seizures the same?
There are different types of seizures, and
they happen for many different reasons.
Some are caused by conditions such as low
blood sugar (hypoglycaemia) or a temporary
change to the way the heart is working.
What seizures all have in common is that
they are usually sudden, short, and cause a
change in the person’s awareness of where
they are, what they are doing, what they are
thinking or their feelings.
Some people have more than one type
of seizure. For example, around 15 in every
100 people with non-epileptic seizures also
have epilepsy.
3

4. What is the difference between epileptic
and non-epileptic seizures?
Epileptic and non-epileptic seizures
can look the same and have the same
features. They can both happen suddenly
and without warning, and can include a
loss of awareness or the person becomes
unresponsive, makes strange or repeated
movements, or shakes (convulses). They can
both cause injury and incontinence (wetting
yourself), and can both happen when awake
and during sleep.
The difference between epileptic and
non-epileptic seizures is their cause.
Epileptic seizures
Epileptic seizures start in the brain. Our
brain controls the way we think, move and
feel, by passing electrical messages from
one brain cell to another. Although epileptic
seizures always happen due to disrupted
brain activity, what happens to the person
during the seizure depends on where in the
brain this disrupted activity happens. There
are many different types of epileptic seizure:
in some the person is aware of what is
happening, in others they become confused
and unaware of their surroundings, or they
may become briefly ‘absent’ or fall to the
ground and convulse (shake).
Epileptic seizures are caused by a
disturbance in the electrical activity of the
brain (and so they always start in the brain).
4

5. In contrast, seizures caused by a condition
outside of the brain are not due to epilepsy.
For example, a seizure caused by a low level
of sugar in the blood, or a faint (syncope)
which is caused by either not enough oxygen
in the blood, or the heart not pumping
enough blood around the body.
See NSE leaflets ‘epilepsy - seizures’ and
‘epilepsy - what is it?’ for more information
about epilepsy.
Non-epileptic seizures
Non-epileptic seizures (NES) are different
from epileptic seizures because they are
not caused by disrupted electrical activity in
the brain. They have a number of different
causes, and different forms, which are
explained in section 2 (page 6).
Other names for non-epileptic seizures
Non-epileptic seizures are sometimes
known by other names such as non-epileptic
attacks. People who have non-epileptic
seizures may be described as having
‘non-epileptic attack disorder’ (NEAD). These
terms are not always helpful because they
describe the condition by saying what it is not
rather than saying what it is.
NES used to be called ‘pseudoseizures’
but this name is unhelpful because it sounds
like the person is not having ‘real’ seizures or
their seizures are deliberately ‘put on’.
A newer name for non-epileptic seizures is
‘dissociative seizures’. This is a helpful term
5

6. because it does not describe the seizures
in terms of epilepsy. It is also a useful term
because it is recognised by the World Health
Organisation (this means that it is included in
the International Classification of Diseases:
a list of all known diseases and conditions).
However, the term dissociative seizures is
often used to refer to one particular type of
NES, as explained in section 3 (page 11).
In this leaflet we have used the term
‘non-epileptic seizures’ because it is currently
a widely used term. However, from section
3 onwards this leaflet concentrates on
dissociative seizures (which is the most
common type of non-epileptic seizure).
2. Causes and diagnosis
What causes non-epileptic seizures?
Non-epileptic seizures (NES) can be divided
into two types: organic non-epileptic seizures
and psychogenic seizures.
Organic NES
These seizures have a physical cause
(relating to the body). They include fainting
(syncope), and seizures with metabolic
causes such as diabetes.
Because these organic NES have a
physical cause, they may be relatively easy
to diagnose and the underlying cause can
be found. For example, a faint may be
diagnosed as being caused by a physical
6

7. problem in the heart. In these cases, if the
underlying cause can be treated the seizures
will stop.
Psychogenic NES
Some NES have a psychological cause and
are called ‘psychogenic seizures’. They are
psychological because they are caused by the
impact of thoughts and feelings on the way
that the brain works.
Psychogenic seizures include different types.
• Dissociative seizures are involuntary and
happen unconsciously. The person has no
control over them and they are not ‘put on’.
This is the most common type of NES. See
section 3 for more about these seizures.
• Some people have other psychiatric
conditions that cause seizures. The best
example is panic attacks. These happen
in frightening situations, when remembering
previous frightening experiences, or in a
situation that the person anticipates may
be frightening. As the name suggests, the
person having them feels intense anxiety.
Panic attacks can cause sweating,
palpitations (being able to feel your
heartbeat), trembling and difficulty
breathing. The person may also lose
consciousness and may shake (convulse).
• Some people have ‘factitious seizures’
- seizures that are consciously or
deliberately ‘put on’. One example of this
7

8. is in Munchausen’s syndrome (a
psychiatric condition in which the person
pretends to have different medical
conditions so that they get treatment).
These seizures are not common: most
NES are not ‘put on’.
Types of NES
NES
Organic NES
Psychogenic NES
Dissociative Other Factitious
seizures psychiatric seizures
conditions
How are NES diagnosed?
When you have seizures your GP will usually
refer you to a specialist for diagnosis. This
will usually be a neurologist (a doctor who
specialises in the brain) to see if the seizures
are epileptic. Or you may be referred to a
psychiatrist or psychologist (as NES are
usually classified as a psychiatric condition).
It may be easier for doctors to try and rule
out possible physical causes first, including
epilepsy. This will influence the types of tests
you might have.
NES can be difficult to diagnose partly
because they can appear to be similar to
epileptic seizures. There are no features that
will definitely tell NES from epileptic seizures.
8

9. Taking a personal history
Many of the tests used to find the cause
of seizures cannot, on their own, confirm a
diagnosis.
Taking a ‘personal history’ can help to find
the cause of your seizures. This includes the
following:
• looking at your neurological history (about
your brain and nervous system and its
development);
• looking at your psychological development
and mental health, including whether you
have had depression or other psychiatric
conditions, or have been subject to stress
and trauma in the past;
• looking at whether there is a family history
of depression or other conditions;
• looking at the history of your seizures,
such as when they first started and when
they happen; and
• looking at whether you have been
diagnosed with epilepsy but your seizures
have never been controlled with
anti-epileptic drugs.
What happens during the seizure
Asking you about what happens to you
during a seizure can be helpful to find the
cause. If you don’t remember your seizures,
the doctor might ask you to bring along
someone who has seen your seizures
(sometimes called a ‘witness’).
9

10. The specialist might ask you about:
• what situations you have seizures in;
• whether you get any warning before a
seizure happens;
• what happens to you during the seizure
or, if you don’t remember, a witness can
help describe what happens to you;
• how long the seizures last;
• what you remember, if anything, about the
seizure afterwards; and
• how you feel afterwards and how long it
takes you to recover.
Tests
Some tests are used to rule out other causes
of seizures, including epilepsy.
• Medical examinations and blood tests can
be used to check your overall health and
see if your seizures have a physical cause
such as diabetes.
• Scans such as CT (computerised
tomography) or MRI (magnetic resonance
imaging) are used to form a picture of your
brain. This may show a physical cause for
epileptic seizures, but would not usually
be helpful in diagnosing NES.
• An EEG (electroencephalogram) records
the electrical activity of the brain. It is
often used to see if seizures are caused
by disrupted brain activity, which helps to
diagnose epilepsy. NES are not caused by
changes in brain activity.
10

11. • Video telemetry involves having an EEG
and being filmed at the same time. This
compares what a person is doing with
what is happening in their brain during
the seizure, to tell the difference between
epileptic and non-epileptic seizures. This
can help to diagnose epilepsy (if, during
a seizure, your brain activity changes)
or diagnose NES (if, during a seizure,
your brain activity does not change).
See NSE leaflet ‘epilepsy - diagnosis’ for
more about these tests.
The specialist will usually explain the results
of these tests to you. If the tests show no
neurological or physical cause for your
seizures, your specialist may consider a
diagnosis of NES. They may then refer you
to a different specialist to diagnose NES.
From this point onwards, this leaflet
concentrates on dissociative seizures.
3. Dissociative seizures
Describing dissociative seizures
We all react to frightening or stressful
situations differently. When we are frightened
we might feel physical symptoms such as a
racing heartbeat or feeling sweaty. When we
feel sad, we might cry. So how we feel
emotionally can sometimes cause a physical
reaction.
11

12. When we have experiences that are
extremely frightening or upsetting,
sometimes they are so emotionally difficult
for us to think about that we cannot
consciously cope with how this makes us
feel. In some cases, we will unconsciously
hide or ‘repress’ the memory of these
experiences. These memories may always
remain hidden and we may never remember
that they have happened.
For some people the memories of these
painful past events can suddenly come up
or ‘intrude’ in to their thoughts or awareness.
This might happen during an emotional or
stressful situation, when there is something
in the environment that unconsciously
triggers the memory, or even in a situation
where the person is stressed but is not
aware that they are stressed. This can cause
a dissociative seizure.
Dissociative seizures happen as a
response to suddenly remembering the
traumatic experience: the person splits off
(or dissociates) from their feelings about the
experience because it is too difficult to cope
with. The seizure happens because their
emotional reaction causes a physical effect.
These seizures are an unconscious reaction
so they are not deliberate and the person
has no control over them.
One way to describe this is by comparing
it to ‘domestic deafness’. Most of us have
had the experience of concentrating so hard
12

13. on reading the newspaper that we don’t
realise when someone is talking to us. This
is like ‘turning the volume down’ to drown out
what is happening around you so you can
concentrate. Dissociative seizures are like
the body’s way of ‘drowning out’ a frightening
or painful memory that intrudes into our
thoughts.
What causes dissociative seizures (DS)?
Any experiences that we have, whether good
or bad, can have a deep and long-lasting
effect on us, and everyone has their own way
of dealing with them. Dissociative seizures
(DS) are often caused by traumatic events
such as:
• accidents;
• severe emotional upset (such as the death
of a loved one);
• psychological stress (such as a divorce);
• difficult relationships;
• physical or sexual abuse; or
• being bullied.
It can be hard to find the cause of someone’s
DS. For some, they start shortly after a
specific event. For others, they may not start
until years later, or they may start suddenly
for no apparent reason. Once DS have
started, they might be triggered or brought
on when the person is stressed or frightened.
Or they might happen spontaneously in
situations that are not stressful or frightening.
13

14. Sometimes, even the fear of having a seizure
can, in itself, trigger a seizure.
Finding the original event that caused the
DS to start might help to find a way to treat
the seizures. But this is not always possible,
and it can be hard to talk about traumatic or
difficult events.
What are the symptoms of DS?
Although DS start as a emotional reaction
they cause a physical effect. Features of the
seizures can include palpitations (being able
to feel your heartbeat), sweating, a dry mouth
and hyperventilation (over-breathing).
Some features of DS are very similar to
epileptic seizures. These physical features
include loss of awareness, loss of sensation,
and loss of control over bodily movement
(which may include having convulsions).
Two examples of dissociative seizures
• Cut-off or avoidance attacks stop the
person dwelling on painful or stressful
thoughts or situations that are happening
to them in the present. This may happen
when the person doesn’t feel able to say
they are finding it hard to cope.
• Seizures caused by a delayed response
to a very stressful event or situation, for
example, being in a war or a disaster, are
a response to past events. These seizures
may be part of post-traumatic stress
disorder (PTSD) - a condition that
14

15. sometimes happens after a traumatic
event. During the seizure the person may
cry, scream or have flashbacks (sudden,
vivid memories of the event). They may
not remember the seizure afterwards.
Who has dissociative seizures (DS)?
DS can happen to anyone, at any age,
although some factors make DS more likely.
DS are:
• more common in women;
• more likely to start in young adults;
• more likely to happen to people who have
had an injury or disease, or who have had
more severe emotional upset or stressful
life events; and
• more common in people with other
psychiatric conditions (such as
depression, anxiety, personality disorders
or people who self-harm).
4. Treating DS
How are DS treated?
The right treatment for DS depends on their
cause. Your specialist may talk to you about
what treatment options might be helpful, and
may refer you to a different specialist.
Medication
If you have DS, your seizures are not
epileptic and will not respond to anti-epileptic
drugs (AEDs).
15

16. If you are already on AEDs, for example if
you were previously diagnosed with epilepsy,
your specialist may suggest you gradually
reduce them. If you have DS and epilepsy,
you take AEDs for your epileptic seizures.
If you also have anxiety or depression,
your specialist might talk to you about
whether other medication, such as
anti-depressants, might be helpful.
Other forms of treatment
Psychotherapy is the recommended
treatment for DS. Psychotherapy refers to
a group of ‘talking’ treatments. Mental health
professionals, including psychiatrists and
psychologists, are trained to give it.
Cognitive behavioural therapy (CBT) is
the most often recommended treatment. CBT
looks at how you think about things, how this
affects you physically and emotionally, and
how it affects what you do (your behaviour).
By changing the way you think about things,
such as how you think about yourself, other
people and the world around you, this may
change the way that you behave. CBT
doesn’t only look at what has happened to
you in the past but also at how things are
affecting you in the present. It looks for ways
to help you to view current situations more
positively and cope with stressful events.
CBT can take several months or longer as
it may take time for you to feel comfortable
talking about your experiences and feelings.
16

17. 5. Living with DS
First aid for DS
The general first aid guidelines for DS are
the same as for epileptic seizures:
• keep the person safe from injury or harm:
only move them if they are in danger;
• if they have fallen, put something soft
under their head to protect it;
• allow the seizure to happen, don’t restrain
or hold them down; and
• stay with them until they have recovered.
See NSE leaflet ‘epilepsy - first aid’ for
more about managing seizures.
Practical help and safety
If you have seizures of any kind you may
be able to apply for benefits, depending on
the effect that your seizures have on you.
Whatever the cause, seizures can be sudden
and unpredictable so keeping safe during a
seizure is important.
For information about safety, and tips for
reducing risks due to seizures, see NSE
leaflet ‘epilepsy - safety’.
Driving regulations
Driving regulations for the UK are set by the
Driver and Vehicle Licensing Agency (DVLA).
DS usually come under the regulations for
‘loss of consciousness or loss of, or altered,
awareness’ which means that you need to
stop driving and tell the DVLA that you have
17

18. DS. These regulations are based on the
possibility of having a seizure while driving
and the risks this could bring.
For more about driving regulations go to
www.direct.gov.uk/motoring
Is DS a disability in the UK?
People with a disability are protected by the
Disability Discrimination Act (DDA). This
means it is unlawful for someone to treat a
person with a disability unfairly because of
their disability without a justifiable reason.
Under the DDA, you have a disability if:
• you have a physical or mental impairment;
and
• your impairment has a major, negative
and long-term (12 months or more) effect
on your ability to carry out day-to-day
activities (such as eating, washing,
walking or shopping). The disability could
affect you being able to move around,
your memory and concentration, or your
ability to understand the risk of danger.
The DDA doesn’t include a list of every
disability covered. Although epilepsy is listed
as a physical disability, DS is not listed. To be
protected by the DDA, you need to show that
you meet the definition of a disability above.
For information about the DDA go to
www.direct.gov.uk or
www.equalityhumanrights.com
18

19. How you feel about your diagnosis
Being diagnosed with any condition can
cause many different emotions, and can
affect many parts of your life. You may
be relieved to know what is causing your
seizures. Or you may find it hard to come to
terms with, particularly if you were previously
diagnosed with epilepsy and have now been
diagnosed with DS.
Being diagnosed with a psychiatric
condition can also feel quite scary or
upsetting because of the stigma around
how we view psychiatric conditions.
Understanding that DS can be your body’s
natural way of reacting to stressful situations
might be helpful.
There is no ‘right’ way to feel about your
diagnosis, but being able to accept it can be
part of helping to improve your seizures.
You might like to talk to someone about
your diagnosis and how you feel about it.
Contact NSE’s helpline. See back cover
for details.
Note: the example used on page 12 is from
John Mellers, Consultant Neuropsychiatrist,
The Maudsley Hospital.
Further information
NSE’s written information, including a list of all
NSE resources, is available from the
helpline or online at www.epilepsysociaty.org.uk
19

20. To become an associate member and receive
information on epilepsy call 01494 601 402 or
email members@epilepsysociety.org.uk
For a fundraising pack or other fundraising
enquiries call 01494 601 300 or
email fundraising@epilepsysociety.org.uk
Epilepsy Information Services
National Society for Epilepsy
Chesham Lane
Chalfont St. Peter
Bucks SL9 0RJ
Telephone 01494 601 300
www.epilepsysociety.org.uk
confidential
Epilepsy Helpline
01494 601 400 (national call rate)
Monday - Friday 10am - 4pm
information... time to talk... emotional support
... translation service available
Telephone Helplines Association accredited
Every effort is made to ensure that all our information is correct
and up to date. Please note that some information may change
after the date of printing. This information is not intended to be
a substitute for medical guidance from your own doctors. NSE
cannot be held responsible for any actions taken as a result of
using NSE information resources.
© National Society for Epilepsy
March 2009 Registered charity number 206186