When a seizure is not caused by epilepsy, it is often psychogenic non-epileptic seizures (PNES). Typically featuring fainting spells, uncontrolled movement and symptoms that are identical in nature to epileptic seizures. However, the cause of PNES is very different and studies are now emerging that show that there may be vast number of veterans with epilepsy caused by PTSD.
Department of Veteran Affairs Findings
A 2014 press release, from the Department of Veterans Affairs medical field, learned that a "recent VA surveillance project highlighting the relationship among traumatic brain injury, post traumatic stress disorder and seizures indicates that Veterans of Iraq and Afghanistan diagnosed with seizures are more likely to also have suffered TBI, PTSD or both."
During 2011, the VA treated more than 87,000 veterans with diagnosed seizure issues and those who had served in operations Enduring Freedom, Iraqi Freedom and New Dawn were far more likely to have also suffered TBI. In fact, the "study suggests that nearly 70 percent of Veterans with seizures also have TBI and PTSD."
As of yet, researchers are not exactly clear on how or why veterans with epilepsy caused by PTSD are in these groups, but they are positive not all seizures are epileptic.
Why should this matter? It boils down to the testing and treatments available. One doctor has explained that PNES is not an abnormal electrical discharge in the brain the way that epilepsy is and treating it with anti-seizure medications is potentially harmful. In another report from the National Institute of Health, statistics indicate that 70% of people with PNES receive anti-epilepsy prescriptions, which can lead to an increase in costs of roughly $10k annually. That same study says that "costs reduce by 84% after diagnosis of PNES is made".
What if PNES is Suspected?
When a doctor suspects PNES, they may request an in-home video EEG study to be performed. This type of study is the gold standard for the diagnosis of PNES. This multiple day test can help doctors to see whether the seizure events are epilepsy or something else.
Also, it is important that we look closely at veterans with epilepsy caused by PTSD because they represent a large amount of important data and statistics. As the NIH report noted, U.S. veterans are a very specific group. They are predominately younger males, have access to primary care and mental health care, and are a group with a much higher frequency of PTSD and TBI.
The data shows the direct relationship between non-epileptic seizures or PNES and veterans. In one table of data, it is revealed that veterans have seizures attributed to TBI at a rate of roughly 58% compared to civilians at 26%. However, testing to determine seizure types can be extremely difficult and demands monitoring via EEG for lengthy periods. In some instances, tests have to run a week before adequate seizure activity can be documented and even then they rarely occur in the presence of the physician. They must be described by the patient and as we know, they are similar to epileptic seizures.
Since veterans with epilepsy caused by PTSD should not be treated as if they are epileptics, there has to be more conclusive studies done to determine the finer distinctions between seizure activities in those with TBI/PTSD seizures and those with epilepsy.
RSC Diagnostic Services delivers in-home ambulatory long-term video EEG. RSC empowers physicians by increasing the diagnostic yield to evaluate, diagnose and treat a variety of neurological symptoms. We are committed to improving patient outcomes and enhancing caregiving.