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Nonepileptic Seizures

Medically reviewed by Last updated on Jun 6, 2023.

What is a nonepileptic seizure (NES)?

A NES is a short loss of control in how you move, think, or feel. It is sometimes called a nonepileptic event or episode. A NES looks like an epileptic seizure, but there are no electrical changes in the brain. Epilepsy medicine will not stop or prevent a NES. A NES is a serious condition. Early diagnosis and treatment are needed to prevent more problems.

What causes a NES?

A NES may be caused by a condition that affects blood, oxygen, and sugar available to the brain. Common triggers are drugs, alcohol, hypoglycemia (low blood sugar), sudden drops in blood pressure, and sleep problems. A NES may also be caused by the body's reaction to severe mental stress. Common triggers are depression, mild head injuries, and sexual or physical abuse.

What are the signs and symptoms of a NES?

  • Twitching in your arms or legs that lasts longer than 2 minutes
  • Crying, screaming, or weeping
  • Head, neck, and spine bent backwards
  • Side to side head movements
  • Strong or powerful pushing of the hips
  • Thrashing or violent movements, such as striking at walls or breaking pieces of furniture
  • Tongue biting

How is a NES diagnosed?

Your healthcare provider will examine you and ask about your symptoms. He or she will also check your blood pressure. If possible, bring someone with you who saw you have an episode. Tell your provider about any health conditions you have. He or she may also ask about any stress you have. You may also need any of the following:

  • Blood tests may show a physical cause of your NES, such as low blood sugar or oxygen levels.
  • An EEG is a test that checks your brain function. Small pads or metal discs are put on your head. Each has a wire that is hooked to a machine. This machine prints a paper tracing of brain wave activity from different parts of your brain. A video-electroencephalogram records behavior and the EEG at the same time. Changes in behavior are related to changes in the EEG.
  • A CT or MRI may show a physical cause of your NES. You may be given contrast liquid to help your brain, blood vessels, and skull show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.

How is a NES treated?

Treatment will depend on the cause of your symptoms:

  • Treatment may be needed for physical causes of NES. For example, medicines may be given for blood sugar or blood pressure problems. Treatment of the cause will prevent a NES from happening.
  • Cognitive behavioral therapy helps you learn to face a feared object or situation slowly and carefully. You will also learn to control your mental and physical reactions of fear.
  • Psychotherapy is therapy that includes your family or people who are close to you. You will be able to talk about NES and anything that may have caused you to develop the condition.
  • Anxiety medicine helps keep you calm and relaxed.
  • Antidepressants help decrease the symptoms of depression.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

View more treatment options

What can I do to manage NES?

  • Ask what safety precautions you should take. Talk with your healthcare provider about driving. You may not be able to drive until you are seizure-free for a period of time. You will need to check the law where you live. Also talk to your healthcare provider about swimming and bathing. You may drown or develop life-threatening heart or lung damage if you have a seizure in water.
  • Tell your friends, family members, and coworkers that you have had a seizure. Give them written instructions to follow if you have another seizure. Your healthcare provider can help you create a list that is specific to your signs and symptoms.
  • Keep a seizure diary. This can help you find your triggers and avoid them. Write down the dates of your seizures, where you were, and what you were doing. Include how you felt before and after. Possible triggers include illness, lack of sleep, hormonal changes, alcohol, drugs, lights, or stress.

What can I do to prevent a NES?

You may not be able to prevent every seizure. The following can help you manage triggers that may make a seizure start:

  • Set a regular sleep schedule. Try to go to sleep and wake up at the same times each day. Sleep problems can trigger a NES. Talk to your healthcare provider if you have trouble sleeping.
  • Exercise as often as possible. Exercise can relieve stress and help you sleep better. You may feel better with 30 minutes of exercise most days of the week. Your healthcare provider can help you create a safe exercise plan.
  • Limit or do not drink alcohol. Alcohol can trigger a NES. Ask your healthcare provider how much alcohol is safe for you to drink. A drink of alcohol is 12 ounces of beer, 1½ ounces of liquor, or 5 ounces of wine.
  • Do not use illegal drugs. Drugs can trigger a NES. Talk to your healthcare provider if you use illegal drugs and need help to quit.
  • Manage stress. Breathe deeply and slowly when you feel stressed or anxious. Relax each part of your body one at a time. Try activities that you find relaxing, such as yoga or a short walk. Music can help you relax. You may also want to join a support group so you can talk with others who have NES. Talk to someone you trust about your feelings.
  • Do not smoke. Nicotine and other chemicals in cigarettes and cigars can make stress and anxiety worse. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.

Call 911 for any of the following:

  • You have chest pain, tightness, or pressure that may spread to your shoulders, arms, jaw, neck, or back.
  • You are have trouble breathing after a seizure.
  • You had a seizure that continued longer than 5 minutes.

When should I seek immediate care?

  • You feel like fainting or are lightheaded or too dizzy to stand up.
  • You were injured during or after a seizure.

When should I contact my healthcare provider?

  • You are depressed and feel you cannot cope with your illness.
  • You are confused or cannot think clearly.
  • You have new or worsening symptoms.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

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