Functional Neurological Disorder (FND) : a patient's guide

including Functional/Dissociative (non-epileptic) Seizures,  Functional Movement Disorder and other functional symptoms

Hemi

neurosymptoms.org

Treatment of Dissociative Seizures / Attacks

Considering how common dissociative seizures are, its really shocking how little research there has been in to what the best treatments are for patients with dissociative seizures.

 

But in recent years there has been some progress in this area. This section is based on that research but also on the authors own experience in trying to assist many hundreds of patients with these attacks to get better.

 

If you haven't read them yet, have a look at these sections before you read on:

 

1. Seizures/ Attacks

 

Its really important to understand that these kinds of attacks are common, do not mean you are going mad or 'losing it', do not result in serious physical injury and are potentially reversible without medication.

 

2.  Understanding the diagnosis

 

Its essential that you feel the doctor has looked in to your case properly and come to the correct diagnosis.

 

3. Psychology? I'm not crazy

 

If your doctor has referred you to a psychologist you may be wondering why. Read this section to help you understand this

 

 

 

 

 

The majoirty of patients with dissociative seizures have a warning before their attacks - not every time, and often its brief just lasting a few seconds.

 

Some patients have a warning but are unable to recall it after the attack. Sometimes a friend or relative will be aware of a warning even if the patient isn't

 

Some patients never have a warning and never become aware of it.

 

But learning to recognise the warning symptoms if you can can be a key factor in learning to gain control of these attacks

 

During the attack you are losing control of your body. The aim of treatment is to find strategies to help you regain control.

 

A really important study of patients with dissociative seizures from London recently showed what kind of symptoms they can have in this warning phase. The authors compared patients with dissociative seizures to patients having epileptic seizures. They showed that symptoms of chest pain, heart racing, shortness of breath, sweating, numbness or tingling or  a feeling of 'going crazy' were very common before attacks in patients with dissociative seizures.

 

These are all symptoms of 'fight or flight' when you have an adrenaline rush. They are also seen during panic attacks. They are symptoms of your nervous system being on "red alert".

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 1. Patients with dissociative seizures often have symptoms that suggest they are going in to  a state of "red alert" prior to the attack (from John Mellers and Laura Goldstein. Ictal symptoms of avoidance behaviour and dissociation in patients with dissociative seizures. Journal of Neurology, Neurosurgery, and Psychiatry 2006;77:616-621 )

 

 

The same study also showed that patients with dissociative seizures were much more likely to develop a fear of going out alone, or being somewhere where there are crowds, or where escape might be difficult. Often this happens because patients fear the embarassment or fuss that might be caused by an attack.

 

Patients with dissociative seizures also sometimes feel concerned about the consequences of an attack. "Perhaps after one of these attacks I might not come round?", "Perhaps I might be left disabled, or 'out of control' in some way".

 

Sometimes the dissociative seizure is your body's way of "getting rid" of the horrible feelings you have during the warning phase. Its not that you are deliberately blacking out but the blackout does at least bring the warning symptoms to an end and sometimes this is how a pattern of blackouts gets established.

 

 

 

 

 

So, you might ask, how does all this help?

 

If you can learn to recognise your warning symptoms, even if they only last a few seconds, you may, over time, be able to learn how to control them sufficiently to avert an attack and regain control of the situation.

 

 

Read on to the next page to find out more

Learning to recognise the warning symptoms ...

...During the attack you are losing control of your body. The aim of treatment is to find strategies to help you regain control.  ...

Learning to do something about the warning symptoms ...

Treatment of Dissociative Attacks Dissociative panic