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Dissociative Seizures

Educational post. Trigger warnings: Medical equipment and description of seizure. 

Written by Tom and Blade.

Why will we cover this? 

Although dissociative seizures are not exclusive for those with dissociative disorders. Some people with dissociative disorders will have seizures.

A dissociative seizure is named differently in different parts of the world. 

I will be referring to them as dissociative seizures or Non-epileptic attack disorder (NEAD). 

However, may also be seen as a one of the many symptoms/types of Functional neurological disorders (FND) its matching term in the ICD-11 is Dissociative neurological symptom disorder. And this post will focus specifically on only the non epileptic seizures. 

It is also known as Psychogenic non-epileptic seizures (PNES), Non-epileptic seizures, and Psychogenic seizures.

If you have known these as "pseudo seizures", it is asked that this is no longer a term that should be used because the name suggests that the seizures are not real or faked by the individual having them or cannot have an ever lasting impact.

What causes a dissociative seizure?

Unlike epileptic seizures they are not caused by abnormal electrical activity in the brain.

A person can get triggered by sensations, thoughts, emotions and difficult situations. Memories of painful events can suddenly come into thoughts or awareness or a build up of stress can happen in a moment. The dissociative seizure can happen as a way to cut off stress or bad memories so that they are not relieved. This can cause a person to start to dissociate. This is when they will feel disconnected from the world around them or make it seem like the world is not real. The brain will "shut down" to protect itself from overwhelming stress. The seizure then happens because the emotional reaction of the person becomes physical.  It is known that extreme emotional distress can cause illnesses and disorders such as non epileptic seizures. 

Some people who have dissociative seizures have them caused by traumatic events. For some they may happen after the event or for others they could start years later. They may start to happen suddenly with no apparent reason at the moment. However, in some people they can be caused by the build up of stress overtime.

When seizures start they can be triggered by stressful or frightening events, even the worry of having a seizure can trigger one. They could also occur spontaneously in non stressful events. Patients may not be able to understand why seizures happen as for some it is hard to recognise the level of stress they are feeling.

What do dissociative seizures look like?

Dissociative seizures can look different from person to person.

You could have episodes of uncontrolled movements, sensations or behaviour. Some dissociative seizures may look more like epileptic seizures or may look more like fainting. Someone may have palpitations, sweat, hyperventilate and have a dry mouth. Someone may fall on the ground or have jerking and shaking movements either on one side or the whole body. A person may lose control of their bladder or bowels and may also bite their tongue. Some people may go unresponsive to people around them and may stare and go blank.

Having seizures caused by a delayed response to a traumatic event may be a part of Post Traumatic Stress Disorder (PTSD). In these seizures a person may have flashbacks, scream or cry and they may not remember the seizure afterwards.

Diagnosis of dissociative seizures.

A specialist will have many ways to tell whether the seizures are epileptic or not. The doctor may be able to tell from detailed descriptions of the seizures or a video of one happening. However, a doctor may ask someone to have an electroencephalogram (EEG) to determine whether electrical changes occur within the person's brain during a seizure. It may also be suggested for a person to have a video-telemetry. This could be done as an inpatient in a hospital or at home. A person will wear EEG equipment for a few days and is linked to a camera. This means that during a seizure the EEG and a video of it happening can be taken at the same time. 

Brain scans such as Magnetic resonance imaging (MRI) or Computed Tomography Scan (CT) scans may also be done to rule out any neurological cause for these seizures. 

Treatment for dissociative seizures.

Patients may also be asked to see a psychiatrist or psychologist. They can offer Treatment such as psychotherapy, stress-reduction (such as relaxation and biofeedback training), and personal support to help you cope with their seizures. 

Talking therapy is useful to understand if there are triggers for the seizures and ways to manage these triggers in daily life. Cognitive behavioural therapy (CBT) is often recommended.

Medication will not help treat non epileptic seizures so they will only be suggested if the patient also has epileptic seizures. Taking medication for non epileptic seizures can cause side effects and do not benefit the person.

It is recommended to keep a normal daily routine. And to make sure that their family and friends are aware and understand. This will mean they will likely be able to help the person in a seizure and prevent harm.

First aid for dissociative seizures (Outsider's perspective):

DO:

- Make sure the person is safe. This can include moving objects away from them. If the person is lying on the floor, put a cushion/something soft under their head.

- Speak Calmly and in a reassuring way to the person

- Non epileptic seizures do not cause damage to the brain no matter how long it happens BUT if you are not sure if it is a dissociative seizure and lasts more than 5 minutes an ambulance must be called. If it is epileptic then a seizure longer than 5 minutes can damage the brain. (Again important to note this is advice given by the NHS of the UK)

- Stay with the person until they have recovered

DO NOT:

- Do not restrain the person. This can cause injury and make the seizure worse.

- Do not put anything in the person's mouth 

- Do not attempt to give medication

Self help tips:

- Write down how you are feeling

- Continue to live normally and not become over cautious. This can help to speed up recovery. It is important to talk to your employer about these seizures and make clear your colleagues know what to do as well.

- Eat and Sleep well

- Build up self confidence

- Green exercise is a great way to boost your mood by being outside even if it is for a short while. Going for a walk outside.

- Fitness programmes can be found online and most can be done from your home 

- Remaining positive 

The sources we have used for this information also have more information on disability rights and benefits for those with dissociative seizures. And on driving regulations. However, these are only applicable to the UK. 

Resources we have used to create this article:

Epilepsy Society: https://epilepsysociety.org.uk/about-epilepsy/what-epilepsy/non-epileptic-seizures

Epilepsy Action: https://www.epilepsy.org.uk/info/seizures/dissociative-seizures-non-epileptic-attack-disorder-nead

Sheffield Teaching Hospital document: https://www.sth.nhs.uk/clientfiles/File/pd3922_NonEpilepticSeizures.pdf

Non-Epileptic Attacks: https://sites.google.com/sheffield.ac.uk/non-epileptic-attacks/home.

Further information:

People's experiences: 

Documentary film https://www.youtube.com/watch?v=MA1EYAg9y5k. Photosensitive Epilepsy Trigger Warning at (9:14 - 9:30 ) and at (45:25 - 46:18)

Websites for more information: 

NeuroKid: https://www.neurokid.co.uk/ - This is a website for children and young people with dissociative seizures but also has information for parents of these children. The website is also available in French at https://www.neurokid.co.uk/fr/.

Non-Epileptic Attacks: https://sites.google.com/sheffield.ac.uk/non-epileptic-attacks/home. A page written by professionals. They have more resources and go into more detail about the self help we have addressed.

FNH Hope UK: https://www.fndhope.org.uk/about-fnd-hope/fnd-hope-uk/. Has fundraising challenges across the UK. They also have online classes such as dance, painting, mindful meditation and yoga.

Charities:

FND Action: https://www.fndhope.org.uk/about-fnd-hope/fnd-hope-uk/. They can provide ID cards for those in the UK struggling with dissociative seizures. 

Brain Charity: https://www.thebraincharity.org.uk/condition/non-epileptic-attack-disorder/. Provides Emotional support and social support for those in the UK and has a helpline. 

Trigger warnings: Medical equipment and description of seizure. Educational post.

It’s practically 2014 and you guys still don’t know how to google if an article is real or not before giving it 100,000 notes

the ghost of one specific homosexual cowboy regularly possesses Tumblr gays

oh, what a good story idea

Hey, that's an even better story idea

Wow, that would be amazing to write

*Stares at screen*

Dehydration seems like such a good way to whump people.

There's the way your head slowly starts to hurt as the day progresses.

There's the way you wake up with your head feeling pinched in, like it might implode.

There's the chapped lips and the dry skin as the dehydration begins to take it's toll.

There's way your head starts to feel fuzzy and thoughts are harder to think.

There's just so many ways to make things worse just by withholding water.

Truths & Myths: Pluralpedia Part 2, Brain Activity in DID

In the fact check, we cover brain activity in switching, brain activity between EPs and ANPs in DID and how this compares to actors trying to imitate having dissociative identities.

All parts exist within one biological body, parts are caused by different brain activity, which means other parts cannot have their own DNA. Moreover, parts do not have physical bodies, any claim to a body is a visualisation tool aiding the part to develop its identity and gain comfort. This visualisation also does not have DNA but that does not mean it cannot be changed. Parts can have different types of relationships though, some parts may consider each other family. This is related to how people have biological or chosen families but in relationships between parts, they reflect those family types rather than actually being those family types.

In the fact check section, we will show studies where actors could not successfully simulate dissociative identities and switch between them. This shows how a person cannot gain dissociative identities by believing they have them or trying to create them by will or want.

Genealogist fact check:

Using quantitative electro-encephalogram (QEEG), it was seen that the change between dissociative identities was seen as beta activity (beta waves are high-frequency, low-amplitude brain waves in the awakened state and are involved in conscious thought and logical thinking) in the frontal and temporal lobes. The frontal lobe is responsible for reasoning, social understanding, executive function, voluntary muscle movements, learning, and recalling information. The temporal lobes are most commonly associated with processing auditory information and encoding memories.

Willogenic fact check:

There have been studies conducted to examine the differences in brain activity between ANPs and EPs in patients with Dissociative Identity Disorder (DID). The terms ANPs and EPs originate from the theory of structural dissociation, which will be discussed in a separate post. In summary, an ANP (apparently normal part) is responsible for carrying out daily tasks, while an EP (emotional part) holds traumatic memories and prevents them from being experienced by the ANPs. Instead, the EPs relive the trauma, rather than being able to experience the present moment like an ANP would. According to this model, EPs are present in patients with PTSD, CPTSD, OSDD, and DID but DID is the only disorder that involves multiple ANPs, setting it apart from the others.

Study one:

In a study, EPs and ANPs in DID patients were shown angry and neutral faces to observe changes in activity and reaction time to a changing coloured dot on the face. This was compared to a control group of actors attempting to simulate an EP or ANP state. The results showed that EPs in DID patients had higher activity in the right parahippocampal gyrus when presented with either face, compared to DID ANPs. The right parahippocampal gyrus is involved in the recall of autobiographical memories, with a right hemispheric predominance, and is also part of the re-experiencing of symptoms in disorders such as PTSD. This supports the theory that EPs play a role in storing traumatic memories. 

The observed activity also suggests and supports the idea that EPs within DID may perceive safe individuals as dangerous and when confronted with reminders of traumatic memories, they may reactivate those memories. While there were other findings in the study, further statistical evidence and a larger sample size are needed to conclude. However, the control group was unable to replicate the activity and reaction time of DID ANPs and EPs. Their reactions were the opposite. When attempting to simulate ANPs and EPs, the actors showed an inverse reaction time and neural brain activity for each state. For example, when the actors were meant to act like ANPs, they tended to react like EPs in DID patients. For ANP-simulating controls neutral faces were salient, they did attract much preconscious attention, as happened for authentic EP. The current findings add to the psychobiological evidence that DID is neither an effect of suggestion and fantasy, nor role-playing.

Study two:

Additionally, a study was conducted to measure brain perfusion, which refers to the passage of fluid through an organ, normally the delivery of blood to a capillary bed in tissue, during rest. The study compared DID patients to controls and found that DID patients have a higher resting state metabolism, the rate at which calories are used, in the Default Mode Network (DMN), which is active when the person is not focused on the outside world such as daydreaming, of the brain. This can be explained by the fact that DID patients’ brains are more focused on attending to their self-states during rest, something that the control group did not experience. 

Moreover, compared to an EP in DID, ANPs in DID showed more metabolism in the bilateral thalamus, the part of the brain that relays sensory and motor signals and regulates both alertness and consciousness. Furthermore, the study found that EPs in DID have increased regional cerebral blood flow in the primary somatosensory cortex, several motor-related parts of the brain, and the dorsomedial prefrontal cortex. The primary somatosensory cortex is involved in action planning and execution, indicating that EPs are highly aware of their body being in a threatening situation. This heightened awareness would trigger the need for defensive motor reactions, making it difficult for them to fulfill the instructions for resting. The dorsomedial prefrontal cortex has many roles important ones such as processing the sense of self and modulating and regulating emotional responses and heart rate in situations of fear or stress.

“Neural processes associated with intended and motivated role-playing of ANP and EP were clearly distinct from those correlated with being ANP and EP following rest instructions.” (From first source in the list)

Conclusion:

Overall, these studies clearly show different alters are due to varying brain activity but also show that DID has a biological backing whose results cannot be replicated through acting or attempting to immediately the presence of dissociative states. 

However, it is always important to note that more research should be done with larger samples, but the studies spoken about here at the time of their research were the largest.

Genealogist:

Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective (Section under Neurobiology of DID)

Beta waves. (Section under Technical Aspects of Brain Rhythms and Speech Parameters)

Frontal Lobe.

Temporal Lobes.

Willogenic:

The Brain in Dissociative Identity Disorder: Reactions to Subliminal Facial Stimuli and a Task-Free Condition.

Default Mode Network.

Bilateral Thalamus. (Section under Abstract)

Dorsomedial Prefrontal Cortex.

Feel free to send us an echo to our page or leave in the comments any questions or suggestions for future parts to this series.

Part one of this series covered DID formation.

Made from the collaborative efforts of the system who run this blog.

Play games with your characters!!!

·:*¨༺𖤐☆✮☆𖤐༻¨*:·

I mean this literally, your favorite game? Play it with your character!

Put your character in The Sims and see what they do. Play The Walking Dead, but make all the choices your character would make. Cards Against Humanity, but your character has to answer everything.

As weird as this sounds, it's a great way to get to know your characters better, and the best part is that you can do it with pretty much any game you like!

Trixed Thursday 28/03/24

Hey man sorry about your colleague. Yeah I heard he passed away. Don’t worry tho he’s with the sea now. Yeah the deep will totally take care of his bones.