New research from Johns Hopkins U. has found that many cases of epilepsy are misdiagnosed due to similar symptoms from an entirely different disease.

According to a paper published in the journal Seizure, these patients are instead suffering from what senior investigator Jason Brandt calls psychogenic non-epileptic seizures, or PNES, resulting from emotional trauma because of the inability to handle stress in an appropriate manner.

True epileptic seizures result from abnormal electrical discharges occurring in the brain, leading to a variety of symptoms characterized as seizures, which can range from long staring spells to violent and uncontrollable muscle spasms. Regardless of the symptom though, the root in all epileptic seizures comes from a disorder in the brain.

However, PNES is caused by an overload of emotional stress which causes an individual to transform mental dysfunction into physical symptoms.

Defunct brain signals from epilepsy can be visualized by an instrument called an electroencephalogram (EEC) which monitors the electrical activity in the brain and can give doctors an inside look at what is happening inside an individual’s head.

This instrument was one of several pieces that led Brandt to believe some diagnoses of epilepsy were faulty. According to a 2005 study on 46 patients, 54 percent of EEC’s were misread as showing epileptic brain signals. Another key indicator that patients with PNES did not have epilepsy was the fact that anti-seizure medications often failed to alleviate symptoms.

In the Hopkins study, the researchers surveyed 40 patients with PNES, 20 patients with epilepsy, and 40 healthy patients about stressful events in the past five years and the amount of stress these events induced. From their data, researchers concluded that all three groups of subjects reported a similar amount of stressful events in the time frame specified. However, the PNES group reported higher levels of stress compared with their epileptic and healthy counterparts.

In further interviews, researchers found the PNES group often failed to cope with their stressful events, leading to increased levels of trauma and subsequent onset of PNES.

Being misdiagnosed caries a high cost for individuals, both financially and emotionally. Costs in medication and hospital stays are high, while social costs can be mentally draining as patients work to fight a seemingly unbeatable disease.
Furthermore, in a particularly interesting twist to PNES, the use of service dogs trained to anticipate epileptic seizures often induced PNES related seizures due to the high suggestibility of PNES patients.

With a higher awareness for the possibility of misdiagnoses, Brandt’s work could open doors for differentiating between epileptic seizures and PNES. Furthermore, proper diagnosis could aid physicians in better psychological treatment for PNES patients, giving them the help they need.