Trauma, Depression Can Cause Seizures

John Smith

When 46-year-old Jane Smith underwent marriage therapy with her husband, the sessions unlocked parts of Jane's memory that she said she repressed for over a decade -- memories with frightening powers.

"I began remembering witnessing my brother being abused... And I began to remember my own abuse," said Jane, who requested her real name not be used. She said she later realized that she was physically and sexually abused by family members starting at age 4.

Jane confronted her parents, saying she wanted to talk about it, but they did not want to.

"Two weeks later I got a letter from them saying, 'Don't contact us again,'" Jane said.

That was when her seizures began.

Trauma Related Seizures

"When her parents sent her a letter rejecting her, she suddenly had a seizure in our house," said her husband, 47-year-old John Smith (not his real name), said. "We were shocked. I thought she was just dying."

But Jane was not dying. Instead she was suffering what are known as psychogenic nonepileptic seizures (PNES), seizure-like episodes that can be brought on due to trauma as well as depression and anxiety.

Although such seizures are well characterized in medical literature, PNES are difficult to treat because the condition falls in the gray area between psychology and neurology -- a place where many doctors are unwilling to go.

"It's an incredible no man's land," John said.

But new research presented at the American Academy of Neurology this week may be a step towards identifying the link between the mind and the brain when it comes to PNES and towards improving treatment.

"There's more and more evidence that there's a bidirectional link between seizures and depression," said Dr. W. Curt LaFrance, an assistant professor of psychiatry, human behavior, and clinical neuroscience and Brown University and the lead author of the study. "If you treat those comorbidities, can you treat those nonepileptic seizures?"

PNES are not the result of irregular electrical activity in the brain, as is the case with epileptic seizures. Instead, PNES have underlying psychological or emotional causes, including post-traumatic stress, depression, anxiety, and chronic illnesses such as cardiac disease or chronic pain.

In his study, LaFrance examined 38 patients with nonepileptic seizures, half of whom were given a placebo drug and half of whom received antidepressants. He found that those treated for depression showed a 40 percent reduction in seizures. The data also showed that patients with more severe depression were less likely to improve after being treated with drugs.

Antidepressants as Therapy

Although LaFrance said he could not be certain that the overall results would not prove random after further trials, he pointed out that when the data was broken down by seizure type, significant seizure reduction occurred in the group that had underlying psychological problems. LaFrance said his results support proceeding with a larger trial on the use of antidepressant therapy on people with PNES.

Overall, experts in the field accept LaFrance's theory.

"People with psychogenic nonepileptic seizures can often have other psychological or psychogenic symptoms [like depression and trauma], and it is that comorbidity that people have been trying to sort out for a long time," said Dr. Martin Goldstein, director of cognitive neurology at the Mt. Sinai School of Medicine in New York.

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