@mpost1234

You stated, “the legs it’s more of a pretzel, but still just so tight and tense nothing can break it until the body releases it.” It's important to remember that you should never hold or restrict seizure movements or force limbs into any position. Seizure contractions can be extremely powerful and potentially lead to broken bones. If your husband is experiencing tonic-clonic seizures, he shouldn't experience pain during the seizure itself since he should be unconscious. However, if he is feeling pain as he begins to regain consciousness during the postictal phase that's understandable.

Just because an EEG does not show electrical abnormalities doesn’t mean your husband isn't having epileptic seizures. In fact, around 50% of individuals with active epilepsy can have normal EEG readings. The most accurate way to diagnose PNES is through video EEG monitoring in an Epilepsy Monitoring Unit (EMU). You can find various EMUs across the US at the following link: https://naec-epilepsy.org/find-a-center.

Here are a few distinctions between epileptic seizures and psychogenic episodes:

1. Epileptic seizures are caused by abnormal electrical activity, while PNES episodes are psychologically induced.
2. Typically, patients with epilepsy have their eyes open during a seizure; in contrast, those having psychogenic episodes usually have their eyes closed.
3. Most epileptic seizures are shorter compared to psychogenic episodes, which tend to last longer.
4. Patients experiencing psychogenic seizures often deal with negative emotions before and during the episode, finding it challenging to process their feelings, which can lead to crying.
5. Epileptic seizures lasting 5 minutes or more are classified as Status Epilepticus and demand immediate medical attention; this is not applicable to PNES.
6. The shaking movements in epileptic seizures are generally synchronous, whereas psychogenic episodes often lack this synchronization.

It's entirely possible for individuals to experience both epileptic and psychogenic seizures. Have you noticed a reduction in seizure activity since your husband started taking Keppra?

My best wishes to both of you.
Jake