Functional and Dissociative Neurological Symptoms : a patient's guide

Hemi

Dissociative (Non-Epileptic) Attacks / Blackouts

Dissociative (Non-Epileptic) Attacks

These are one of the commonest functional/ dissociative symptoms seen in neurology

Dissociative attacks are also called ‘non-epileptic attacks’, 'dissociative seizures', 'psychogenic seizures' and ‘functional seizures/attacks’. I have described them as ‘dissociative attacks’ on this website.

Dissociative attacks are disabling and frightening attacks that look very similar to epilepsy. People can experience shaking attacks or attacks when they simply ’blackout’ often for quite a long time

Unlike epilepsy, dissociative attacks are not due to abnormal electrical activity in the brain or another neurological disease. They are however due to a temporary problem in the way the nervous system is working, a bit like a trance like state. They are potentially completely treatable, although not with tablets and the treatment is not that easy.

Dissociative attacks are common. Nearly half of all people brought in to hospital with suspected serious epilepsy have them. Many patients with dissociative attacks will have been wrongly diagnosed as epilepsy at some point and may have even taken drugs for epilepsy.

What are the typical features?
There are two main types of dissociative attack:

1. With movements – typically the patient has thrashing movements that look just like a generalised epileptic seizure (previously called ‘grand mal’)

2. Without movements – in these attacks patients fall down to the ground and lie motionless and unresponsive, often for many minutes

Your doctor will be looking for specific and typical features of dissociative attacks that are different to epilepsy. These include:

• Long duration of attacks
• The nature of abnormal movements of your head and limbs if there are any
• The presence of a prolonged period of unresponsiveness
• The appearance of your eyes and mouth during the attack
• Whether you had any warning before the attack. “Warnings” before dissociative attacks can be of variable length. Their duration can vary from being completely absent, to several hours. There is sometimes a pattern of escalating and frightening physical symptoms before an attack, often with dissociative symptoms (see below and the page on ‘dissociation’).
• Patients with dissociative attacks often find it even harder to describe their attacks than patients with epilepsy

Making a diagnosis of dissociative attacks requires the doctor to be expert in the diagnosis of epilepsy, since epilepsy comes in many different forms. The two types of problem can look very similar, even to well trained observers such as paramedics, nurses and even hospital physicians

Why are my tests normal?
In dissociative attacks all the parts of the nervous system are intact, they are just not working properly at certain times. Your doctor will make this diagnosis after listening to what happens during an attack and talking to other people that have seen one .

Patients with dissociative attacks have normal brain scans and other tests such as an EEG or ‘brain wave’ test.

Am I imagining it then?
The answer is ‘no’ but click on ‘All in the mind’ above to find out more

Why do they happen?
Dissociative attacks are a complex problem. They arise for different reasons in different people. Often the symptoms are accompanied by feelings of frustration, worry and low mood but these are not the cause of the problem.

We recognise a number of different situations in which dissociative attacks can arise. Your symptom may fall in to one of these categories although often none of these appear relevant:

1. Randomly — One of the most confusing things about these attacks is that they often happen out of the blue without warning.

2. At rest not distracted - Dissociative attacks and the trance like state that goes along with them are more likely to occur when you are resting doing nothing, for example in bed or on the sofa. If you are distracted or focusing on something else, its difficult for that trance feeling to 'overtake' you.

3. With hyperventilation - In some people these attacks can occur at the same time as a shallow and rapid breathing pattern called hyperventilation. You may not even notice that you are breathing too fast but others may do so. If you are hyperventilating this may be making the attack worse. It is useful to know this because it may provide a way of stopping future attacks at an earlier stage. Other physical symptoms you may experience during an attack are hot flushes, a tight chest and tingling in your hands. Sometimes these symptoms are more clearly those of a panic attack.

4. With depersonalisation/derealisation—These words describe dissociative symptoms that many people have at the same time as their dissociative seizures. This is usually a frightening feeling that things around you are not quite real, or that you don’t quite feel connected to your body or a feeling that everything is far away and weird. If you have these symptoms it is helpful to know what they are and that they are part of the attack. Many people who have never experienced these symptoms before are so frightened by them that they think they might be dying. You can get an ‘out of body experience’ with these attacks but you cannot die from them.Often people describe being aware of people around them but being unable to talk to them.

Patients with dissociative attacks often have a brief warning least 50% of the time. Some have no warning. Others have a warning every time. Quite often patients start out with a warning which over time gets shorter and shorter and may disappear.

Learning about this warning phase, learning to prolong it and learning how the blackout may be your body's response to these horrible warning symptoms can be a key part of learning to overcome dissociative seizures

Click on Treatment to find out more in general and find the specific page on the treatment of dissociative attacks

There are now some useful links on the web

www.nonepilepticattacks.info is a detailed site launched in February 2011 with information about dissociative (non-epileptic) attacks. Its well worth reading through.

The Non-Epileptic Attack Disorder Trust (NEAD trust) is a new organisation with a growing range of useful resources for patients including a forum.

NEAD Scotland also has useful information for patients including a live chat room and forum. Again the emphasis on this website is more on psychological factors and trauma than on my own but there is much common ground

The video below is from Youtube. It shows typical features of a dissociative seizure. Remember though that some dissociative seizures consist of falling down and lying still. They dont all have shaking movement associated with them. The individual gave their consent for the video to appear on Youtube leaving the following message

Uploaded on Feb 23, 2012
20 year old male, having a non-epileptic seizure. The young man had a 30 minute warning in advance (Aura).
The young man has given his permission for this video to be shared on this channel. This video is to be used for educational purposes to raise awareness for those who suffer from the Non-Epileptic Attack Disorder.

Brought to you by Project NEA (www.projectnea.org.uk)

Links for Dissociative (Non-Epileptic) Attacks