PSYCH 035: Neuropsychiatric Aspects of Epilepsy and Psychogenic Nonepileptic Seizures

Seizures are among the most dramatic manifestations of brain dysfunction - but not all seizures arise from the same mechanisms. This chapter explores the neuropsychiatric dimensions of epilepsy alongside psychogenic nonepileptic seizures (PNES), where outwardly similar events emerge from fundamentally different processes.In this episode, we examine epilepsy as a disorder of abnormal, excessive neuronal firing, producing transient disruptions in consciousness, perception, and behaviour. Beyond the seizures themselves, we explore interictal and postictal states - where mood, cognition, and personality may be altered.We then turn to psychogenic nonepileptic seizures, where episodes resemble epileptic seizures but arise from psychological mechanisms rather than abnormal electrical activity. These events are not voluntary; they reflect complex interactions between stress, trauma, and neurobiological vulnerability.A central theme is differentiation. Careful clinical assessment, supported by investigations such as EEG, is essential to distinguish between these conditions - as management strategies differ fundamentally.This chapter highlights a profound clinical reality: similar behaviours can arise from very different underlying processes. Understanding those processes is essential - not only for accurate diagnosis, but for compassionate and effective care.Key Takeaways* Epilepsy involves abnormal, excessive neuronal activity producing seizures.* Neuropsychiatric features can occur before, during, and after seizures.* Psychogenic nonepileptic seizures resemble epilepsy but arise from psychological mechanisms.* PNES are not voluntary and require careful, non-judgemental management.* Differentiation between epilepsy and PNES is clinically essential.* EEG and clinical observation support diagnosis.* Similar outward presentations can reflect fundamentally different processes. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit drmanaankarray.substack.com/subscribe