Non-epileptic attack disorder

Non-epileptic Attack Disorder

Non-epileptic Attack Disorder (NEAD) is a condition characterized by episodes that resemble epileptic seizures but are not caused by electrical disruptions in the brain. These episodes are often referred to as psychogenic non-epileptic seizures (PNES) and are typically associated with psychological factors rather than neurological abnormalities.

Overview

NEAD is a complex disorder that can be challenging to diagnose and manage. It is important to differentiate NEAD from epileptic seizures because the treatment approaches differ significantly. While epileptic seizures are treated with antiepileptic drugs, NEAD often requires psychological interventions.

Causes

The exact cause of NEAD is not fully understood, but it is believed to be associated with psychological stress, trauma, or other mental health conditions. Common factors that may contribute to NEAD include:

• Psychological stress: High levels of stress or anxiety can trigger non-epileptic attacks.
• Trauma: A history of trauma, such as physical or sexual abuse, is often reported in individuals with NEAD.
• Mental health disorders: Conditions such as depression, anxiety disorders, and post-traumatic stress disorder (PTSD) are frequently associated with NEAD.

Symptoms

The symptoms of NEAD can vary widely among individuals but often include:

• Convulsions or shaking
• Loss of consciousness or awareness
• Changes in behavior or mood
• Unresponsiveness

Unlike epileptic seizures, NEAD episodes do not show abnormal electrical activity in the brain when monitored with an electroencephalogram (EEG).

Diagnosis

Diagnosing NEAD involves a comprehensive evaluation to rule out epilepsy and other medical conditions. Key diagnostic steps include:

• Clinical history: A detailed history of the episodes and any associated psychological factors.
• Video-EEG monitoring: This is the gold standard for differentiating NEAD from epileptic seizures. During an episode, the EEG will not show the electrical changes typical of epilepsy.
• Psychiatric assessment: Evaluation by a mental health professional to identify underlying psychological issues.

Treatment

The treatment of NEAD focuses on addressing the underlying psychological factors. Common approaches include:

• Cognitive-behavioral therapy (CBT): A type of psychotherapy that helps patients understand and change their thought patterns and behaviors.
• Stress management techniques: Methods such as relaxation training, mindfulness, and biofeedback can be beneficial.
• Medication: While antiepileptic drugs are not effective for NEAD, medications for anxiety or depression may be prescribed if these conditions are present.

Prognosis

The prognosis for individuals with NEAD varies. With appropriate psychological treatment, many patients experience a reduction in the frequency and severity of their episodes. However, some individuals may continue to experience episodes despite treatment.

Also see

• Epilepsy
• Psychogenic disorder
• Conversion disorder
• Functional neurological disorder