I found something you all might be interested in.
My son has this issue as well and from what I noticed over the handful of times I witnessed it, he gets afraid, starts to panic and his breathing slows down. This is when he gets an overwhelming nausea and he can tell when he is about
to faint, knowing he will probably have a seizure next makes him more anxious and then there he goes. His breathing stops, preventing oxygen to his brain and the seizure hits. When he was 4 it happened when he grabbed a hot curling iron - he just fell into my arms but didn't have a seizure. Then whenever he would get sick and vomit he would also pass out - not wanting to be present for all that gross stuff. Now giving blood, shots, any medical act of any kind that even mildly hurts or is uncomfortable takes him through the dance again. I believe he has mentally conditioned himself out of fear, protection or whatever, but it's real, it happens and there is no talking their way out of it.
sychogenic nonepileptic seizures (PNES), or pseudoseizures are paroxysmal episodes that resemble and are often misdiagnosed as epileptic seizures; however, PNES are psychological (i.e., emotional, stress-related) in origin.
Paroxysmal nonepileptic episodes can be either organic or psychogenic. Syncope, migraine, and transient ischemic attacks (TIAs) are examples of organic nonepileptic paroxysmal symptoms. This article covers only PNES.
The terminology on the topic has been variable and, at times, confusing. Various terms are used, including pseudoseizures, nonepileptic seizures, nonepileptic events, and psychogenic seizures. PNES has been the preferred term in the literature, but in practice, the term "seizures" is confusing to patients and families, so that it is probably best to replace it with more general terms that so not imply epilepsy, such as "attacks" or "events."
PNES are common at epilepsy centers, where they are seen in 20-30% of patients referred for refractory seizures. PNES are probably also common in the general population, with an estimated prevalence of 2-33 cases per 100,000 population, which makes PNES nearly as prevalent as multiple sclerosis or trigeminal neuralgia.
Diagnostic Criteria (DSM-5)
By definition, PNES is a psychiatric disorder; more specifically it is a conversion disorder, which falls under the diagnostic category of somatic symptom disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). According to the DSM-5 classification, neurological symptoms that are found, after appropriate neurological assessment, to be incompatible with neurological pathophysiology can fall under conversion disorder, factitious disorder, or malingering.
The specific DSM-5 criteria for conversion disorder are as follows :
One or more symptoms of altered voluntary motor or sensory function
Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions
The symptom or deficit is not better explained by another medical or mental disorder
The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation
PNES falls under the symptom subtype of “with attacks or seizures.”
Factitious disorder and malingering imply that the patient is purposely deceiving the physician (i.e., faking the symptoms). The difference between factitious disorder and malingering is that, in malingering, the reason for the deception is tangible and rationally understandable (albeit possibly reprehensible) such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs. In factitious disorder, the motivation is a pathologic need for the sick role.
An important corollary is that malingering is not considered a mental illness, whereas factitious disorder is. As such there are no specific diagnostic criteria for malingering.
A generally accepted view is that most patients with PNES have conversion disorder, rather than malingering or factitious disorder.
Although the DSM-5 classification is simple in theory, knowing whether a given patient is faking it is nearly impossible. In some circumstances, intentional faking can be diagnosed only by catching a person in the act of faking (e.g., self-inflicting injuries, ingesting medications or eye drops to cause signs, putting blood in the urine to simulate hematuria).
Malingering may be underdiagnosed, partly because the diagnosis is essentially an accusation.
Psychogenic nonepileptic seizures (PNES) in perspective
The neurology and epilepsy literature on PNES often implies that PNES is a unique disorder. In reality, PNES is but one type of somatic symptom disorder. How the psychopathology is expressed (PNES, paralysis, diarrhea, or pain) is different only in the diagnostic aspects. Fundamentally, the underlying psychopathology, its prognosis, and its management are no different in PNES than they are in other psychogenic symptoms. Whatever the manifestations, psychogenic symptoms are a challenge in both diagnosis and management.
Psychogenic (i.e., nonorganic, functional) symptoms are common in medicine. By conservative estimates, at least 10% of all medical services are provided for psychogenic symptoms. These symptoms are also common in neurology, representing approximately 9% of all inpatient neurology admissions and probably an even higher percentage of outpatient visits. Common neurologic symptoms that are found to be psychogenic include paralysis, mutism, visual symptoms, sensory symptoms, movement disorders, gait or balance problems, and pain.
For several neurologic symptoms, signs or maneuvers have been described to help differentiate organic from nonorganic symptoms. For example, limb weakness is often evaluated by means of the Hoover test, for which a quantitative version has been proposed. Other examples are looking for give-way weakness and alleged blindness with preserved optokinetic nystagmus. More generally, the neurologic examination is often aimed to elicit symptoms or signs that do not make neuroanatomic sense (e.g., facial numbness affecting the angle of the jaw, gait with astasia-abasia or tight-roping).
Every medical specialty has its share of symptoms that can be psychogenic. In gastroenterology, these include vomiting, dysphagia, abdominal pain, and diarrhea. In cardiology, chest pain that is noncardiac is traditionally referred to as musculoskeletal chest pain, but it is probably psychogenic. Symptoms that can be psychogenic in other specialties include shortness of breath and cough in pulmonary medicine, psychogenic globus or dysphonia in otolaryngology, excoriations in dermatology, erectile dysfunction in urology, and blindness or convergence spasms in ophthalmology.
Pain syndromes for which a psychogenic component is likely include tension headaches, chronic back pain, limb pain, rectal pain, and sexual organ pain. Pain is, by definition, entirely subjective; therefore, to confidently say that pain is psychogenic is essentially impossible, and the term psychogenic is all but discredited in the pain literature. One could even argue that all pains are psychogenic; therefore, psychogenic pain is one of the most uncomfortable diagnoses to make. In addition to isolated symptoms, some consider certain syndromes to be at least partly and possibly entirely psychogenic (ie, without any organic basis). These controversial but fashionable diagnoses include fibromyalgia, fibrositis, myofascial pain, chronic fatigue, irritable bowel syndrome, and multiple chemical sensitivity.