Non-epileptic seizures and PTSD

Non-epileptic seizures from PTSD & C-PTSD

The flashbacks, nightmares and other symptoms associated with Post Traumatic Stress Disorder are known as quite common in relation to the one in four people in the UK with a diagnosis of PTSD.

However, one effect of PTSD – and especially complex Post Traumatic stress disorder (C-PTSD) – sometimes gets overlooked or misdiagnosed. The instinctive ‘freeze’ response to trauma can be in a more extreme form, and be a type of seizure.

It is easy to think of seizures as dramatic shaking or when the individual thrashes around. However, they can also be a loss of awareness, when the person enters a coma-like state. That’s because a seizure of any kind is an electrical disturbance in the brain that can affect not just physical movement, but also behaviour and emotions.

Seizures can also vary in frequency and severity – lasting anything from a few seconds to a few minutes. Seizures that continue beyond five minutes are generally viewed as a medical emergency.

Insights on PTSD-linked seizures

There are various categories of generalised seizures that are associated with a brain injury or a chronic condition such as epilepsy. They are believed to involve many areas of the brain, and people can have these multiple times a day including in clusters.

People with PTSD and C-PTSD are more likely to experience a seizure that involves electrical activity in one area of their brain. These are sometimes referred to as non-epileptic attack disorder (NEAD) or can be categorised as either focal seizures with impaired awareness or focal seizures without loss of consciousness.

A focal seizure with impaired awareness is an almost coma-like state when the environment around you fades away. Though you may still be moving while in this ‘trance’, carrying out involuntary repetitive actions like rubbing your hands, walking in circles or rocking. Afterwards, you would probably be unaware that you just had a seizure.

As the name implies, you would be aware of focal seizures without loss of consciousness. However, while they last, you could feel a wide range of short-term effects including an inability to speak or move, involuntary jerking of an arm or leg, dizziness and seeing flashing lights.

Either of these types of non-epileptic seizures can be accompanied by heart palpitations, excessively heavy breathing, sweating and a dry mouth. Occasionally, people having one of these seizures loses control of their bladder too or bites down on their tongue.

How would you know someone with PTSD was having a seizure?

It can be difficult to tell, but the signs would include the person staring into space intently, not responding when you speak to them or touch them, or displaying sudden confusion.

One PTSD UK Supporter contacted us, as her daughter experiences these ‘coma-like states’. ““There are times when the demands of life experiences and memories become too much, sometimes the smallest (or so it seems to others) things can trigger some really frightening experiences. My daughter experiences moments of unresponsive states which can affect her movement, hearing, speech and sight – sometimes all at once. This can look like she is unconscious but we make sure that she knows she’s safe, and continue to talk to her throughout these periodic events to ensure she doesn’t feel too scared. She has explained that she experiences flashbacks at times of these unresponsive states and they can be highly distressing. It’s a way for her body to “give her a break” from the distress that she experiences through thoughts/memories. Trauma has caused a significant impact on her life and it has affected how she processes environments such as schools, social activities and relationships with professionals and even ‘safe’ family members” 

It is common for this PTSD-linked seizure to be accompanied by a strong rush of cognitive or emotional stimulation beforehand, including a surge of anxiety or fear, before the person becomes quiet and unresponsive for a few seconds.

“I fell down again, and this time I stayed down. I remember lying there unable to get up. I could hear everything going on around me but it felt very distant. I felt like I was slightly outside of my body — it was a really weird feeling. And I’m thinking “What’s going on?” I don’t feel like anything is seriously wrong with me, it’s just that my body wants to get on the floor for a while. It’s like spontaneous lying down, except I fall.”

What causes dissociative seizures?

These localised ‘dissociative’ seizures are believed to be an electrical misfire with an emotional or mental origin, rather than being a symptom of neurological damage. The trigger can be a painful thought or a reaction to something you see or hear for example.

In effect, your brain ‘protects’ you from something that causes you great distress or fear, by temporarily ‘shutting off’ your cognitive abilities or the memories that are surfacing. This is involuntary and hard to predict or control. Particularly in the case of C-PTSD, when the original trauma has often been deeply buried.

One study of women who had recently experienced sexual violence found a “significantly higher prevalence of dissociative seizures (43.7%)’ The researchers concluded that a sense of shame was a strong trigger.

Treating seizures associated with PTSD

Brain scans and a personal history can help medical professionals differentiate between neurological damage and seizures caused by PTSD and other mental health illnesses.

They may prescribe antidepressants or anti-anxiety medications. However, as always, the path to sustainable recovery from PTSD is to find a therapeutic intervention that works for you. This often pivots on cognitive behavioural therapy (CBT) which retrains your brain to respond to external stimulation and your own memories in a more positive, calm way, or EMDR which can help you process the trauma into a memory that is fully processed and won’t cause you distress..

One report noted, “While patients with dissociative seizures were largely neglected for much of the 20th century by clinicians and academics alike, interest with regard to understanding and effectively treating the condition has increased in the past two decades.

Psychotherapy, particularly cognitive behavioural therapy (CBT), has been highly regarded by leaders in the field as a promising treatment for dissociative seizures.”

However, this report concluded – as PTSD UK regularly says – that there is not one ideal treatment for PTSD or C-PTSD. A variety of therapies, including mindfulness-based interventions, should be considered.

At least being aware of this type of seizure may help you find ways to spot potential triggers, gain help and support, and avoid a misdiagnosis of epilepsy.

Footnote: This article has focused on focal seizures that are an involuntary mechanism for disassociating yourself from a trauma response. That is not the same as PTSD-linked epilepsy, which will be covered in a future article within our online resources.

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It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help. For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy – but the main treatment options in the UK are psychological treatments such as Eye Movement Desensitisation Reprogramming (EMDR) and Cognitive Behavioural Therapy (CBT).

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