NCCHC: Psychogenic Seizures — A Real Issue in Corrections


Seizure management can be difficult in the correctional setting, due in part to the concern that an inmate may be fabricating a seizure history or seizure activity in order to obtain perks or desired benefits.

Into this context is placed the very real condition of Psychogenic Non-Epileptic Seizures (PNES). Gregory Famiglio, MD, MBA, CCHP briefed attendees at the recent National Commission on Correctional Health Care (NCCHC) annual meeting about the condition in corrections.

Dr. Famiglio identified the condition as “a maladaptive coping mechanism to deal with stress” and “a physical manifestation of a psychological disturbance.”

This seizure category is not caused by epileptic electrical brain activity — it is an emotional, stress-induced, body reaction caused by past psychological traumatic events such as physical or sexual abuse.

These seizures are not being ‘faked.’ The individual is not aware of when they will emerge. The stress of incarceration can increase psychogenic seizures in those susceptible to them.

Inmates Have More Seizure Activity
It is not your imagination that there is so much seizure activity seen (or claimed) in the inmate population. Incarcerated persons have 400 percent more seizure disorders than those in the community (one percent of US population has a seizure disorder versus four percent of the inmate population). This could be due to the background or life history of this group including:

• Illicit drug use
• Head trauma
• Abusive background (domestic violence, child or sexual abuse)

This final category can lead to PNES. Up to 1/3 of seizure disorders end up diagnosed as psychogenic. They are most prevalent in the second and third decades of life — a prime age group in the corrections system. The majority (90 percent) of victims are female.

Responding to Psychogenic (PNES) Seizures
Psychogenic Seizures can be diagnosed by their presentation and EEG-video monitoring. Once determined, the treatment is very different from the treatment of other seizure disorders. Often persons with PNES have been treated with standard antiepileptic drugs for several years before a correct diagnosis is made.

Understanding the high level of seizure disorder in the inmate population and the nature of PNES can help custody officers and administrators to better manage security procedures.

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