KAREN: I ENLISTED IN THE NAVY WHEN I WAS ABOUT 19.
I WASN'T IN A REAL LONG TIME BECAUSE I DID GET MARRIED,
AND WHEN I BECAME PREGNANT WITH MY FIRST CHILD,
I OPTED OUT OF THE NAVY.
I HAD BACK SURGERY IN 2013.
AND IT WAS KIND OF AN EMERGENCY THING.
AND THE OUTCOME COULD WELL HAVE BEEN,
I COULD HAVE BEEN PARALYZED.
WHEN I CAME HOME, I STARTED HAVING SOME SHAKING.
DAN: HER SHOULDERS STARTED SHAKING.
AND THEN HER WHOLE BODY STARTED SHAKING.
KAREN: IT WAS KIND OF A JERKY SHAKING
THAT I DIDN'T HAVE CONTROL OVER.
SOMETHING WAS GOING ON,
AND POSSIBLY EPILEPSY.
DR. ALTALIB: SO AN EPILEPTIC SEIZURE
IS WHEN THERE'S ELECTRICAL DISCHARGES IN THE BRAIN
THAT ARE NOT SUPPOSED TO BE THERE.
PNES, WHICH STANDS FOR PSYCHOGENIC NONEPILEPTIC SEIZURE,
IS DIFFERENT THAN EPILEPTIC SEIZURES
IN THAT YOU DON'T HAVE THESE ABNORMAL ELECTRICAL IMPULSES IN THE BRAIN.
SO PSYCHOGENIC MEANS SOMETHING THAT IS PSYCHOLOGICALLY DRIVEN.
SO IT IS VERY DIFFICULT, MAYBE EVEN IMPOSSIBLE,
FOR A LAYPERSON TO TELL THE DIFFERENCE
BETWEEN A PSYCHOGENIC SEIZURE OR AN EPILEPTIC SEIZURE.
FOR A FAMILY MEMBER WHO'S WITNESSING THIS,
IT'S QUITE SCARY EITHER WAY.
SOME PEOPLE MIGHT THINK IT'S STRANGE
THAT A PSYCHOLOGICAL PROBLEM
MANIFESTS AS A PHYSICAL SYMPTOM, HOWEVER IT'S VERY COMMON.
IT'S VERY SIMILAR TO WHEN A PERSON HAS BUTTERFLIES IN THEIR STOMACH.
THEY HAVE A SENSATION THAT'S VERY REAL,
IT'S A VERY REAL EXPERIENCE FOR THEM,
BUT THOSE ARE OFTEN DRIVEN BY BEING NERVOUS
OR KIND OF TUCKING IN EMOTIONS THAT MANIFEST SOME OTHER WAY.
DR. LAFRANCE: DIAGNOSIS IS THE FIRST STEP IN TREATMENT.
YOU REALLY HAVE TO APPROACH IT WITH A SENSE OF HUMILITY
BECAUSE YOU CAN BE FOOLED BOTH WAYS.
YOU CAN HEAR A HISTORY THAT RAISES A QUESTION FOR ONE
AND IT'S THE OTHER.
YOU MAY ACTUALLY OBSERVE A SEIZURE,
AND IT LOOKS LIKE IT COULD BE NONEPILEPTIC SEIZURE,
BUT IT TURNS OUT TO BE EPILEPSY.
DOCTOR: KAREN AND DAN, THIS WILL BE THE,
UH, EPILEPSY MONITORING UNIT
THAT YOU'LL BE IN FOR THE, UH, NEXT 5 DAYS.
DR. LAFRANCE: THE VIDEO EEG IS THE GOLD STANDARD
FOR DIAGNOSING NONEPILEPTIC SEIZURES.
PATIENTS COME INTO THE MONITORING UNIT
AND THEIR TYPICAL EVENT OR EVENTS ARE CAPTURED.
AND THE VIDEO SHOWS THE BEHAVIOR
WHILE THE EEG SHOWS THE BRAIN ACTIVITY.
KAREN: THEY HAD ME PRESS A BUTTON EVERY TIME THAT I FELT THE SEIZURE,
THEN THEY COULD SEE ON THE VIDEO MY MOVEMENT.
SO THEY SAW THE MOVEMENT, BUT THERE WAS NO BRAIN ACTIVITY
THAT WOULD INDICATE EPILEPSY.
DR. ALTALIB: AS WE DISCUSSED WHILE YOU WERE IN THE HOSPITAL,
IT DOES--YOU KNOW, WE KNOW YOU HAVE PSYCHOGENIC NONEPILEPTIC SEIZURES...
SO OFFERING THE PATIENT THE DIAGNOSIS
OF THE PSYCHOGENIC NONEPILEPTIC SEIZURE CAN BE QUITE TRICKY,
'CAUSE ON THE ONE HAND, IT DOES ANSWER THEIR QUESTION
OF WHAT'S GOING ON.
ON THE OTHER HAND,
IF THE NEUROLOGIST IS NOT BEING PARTICULARLY SENSITIVE,
THEY MIGHT COME OFF AS DISMISSING IT
AS ALL IN YOUR HEAD.
KAREN: HE KIND OF EXPLAINED IT LIKE
IT'S NOT JUST PSYCHOLOGICAL, IT'S NOT JUST PHYSICAL.
IT'S ALL JUST A PIECE OF THE SAME PIE.
I'M THE TYPE OF PERSON THAT TENDS TO GET PHYSICAL SYMPTOMS
THAT ARE PARTIALLY FROM MY PSYCHE OR MY EMOTIONS.
SO IT DIDN'T OVERLY SURPRISE ME
AND I JUST WAS EAGER TO GET SOME HELP
AND KIND OF MAKE SURE THAT I COULD GET THAT UNDER CONTROL.
DR. ALTALIB: FORTUNATELY, WE DO HAVE TREATMENTS FOR THIS.
AND, UH, THE TREATMENT IS COGNITIVE BEHAVIORAL THERAPY
OR SOME TYPE OF THERAPY
WHICH ADDRESSES THE UNDERLYING PSYCHOLOGICAL DISTRESS
THAT'S LEADING TO THESE PSYCHOGENETIC SEIZURES.
DR. LAFRANCE: THAT THERAPY ENTAILS LOOKING AT PAST AND PRESENT TRAUMAS AND ABUSE.
IT ALSO LOOKS AT WHAT WE CALL CO-MORBID
OR CO-OCCURRING SYMPTOMS
LIKE DEPRESSION, ANXIETY, POSTTRAUMATIC STRESS DISORDER.
UH, IT USES THE BEST OF THE DIFFERENT PSYCHIATRIC THERAPIES.
KAREN: WHEN I FIRST AGREED TO DO THE, UM,
THE SESSIONS WITH DR. LAFRANCE, I'LL BE HONEST,
I WAS THINKING, WELL, YOU KNOW, THIS PROBABLY WON'T HELP,
BUT I NEED TO TRY SOMETHING.
SO WHAT HE DID, HE GAVE ME A WORKBOOK AND A SEIZURE LOG.
AND I HAD TO LOG EVERY TIME I HAD A SEIZURE ALL WEEK.
I HAD TO READ AND DO HOMEWORK. WHAT WAS THE TRIGGER?
HOW ARE YOU FEELING ABOUT THIS?
AND THEN WE WOULD DISCUSS THOSE THINGS.
DAN: KAREN WORKED VERY DILIGENTLY AT THIS.
SHE TREATED IT LIKE A SCHOOL COURSE.
UH, I'D COME HOME FROM WORK, SHE'D HAVE HER HEAD IN THE BOOK.
SHE KEPT A VERY IMMACULATE JOURNAL
ON ALL THE SEIZURES SHE HAD.
SO SHE WOULD-- SHE WORKED VERY HARD.
DR. LAFRANCE: LET'S TAKE A LOOK AT YOUR SEIZURE LOG.
SOME OF MY PATIENTS HAVE SAID THAT THIS IS
THE HARDEST WORK THAT THEY'VE EVER DONE.
BECAUSE MANY TIMES WHEN YOU'RE TALKING ABOUT PAST EVENTS
THAT ARE DIFFICULT TO ADDRESS, THOSE GET BOXED UP.
AND DOING THIS WORK ACTUALLY INVOLVES OPENING UP THAT BOX.
AND WHEN THAT HAPPENS, SOMETIMES SYMPTOMS COME OUT.
BUT I THINK THAT'S ONE OF THE KEY BENEFITS
OF THIS TREATMENT APPROACH IS THAT THE SEIZURE COUNSELOR
IS THERE WITH THE PATIENT,
AND THEY ARE WALKING THROUGH INTO THESE DIFFICULT AREAS
TO BE ABLE TO LOOK INTO THAT DARK SPACE.
UH, BUT WITH THE TOOLS THAT THE PATIENTS HAVE,
THEY'RE ABLE TO COME OUT ON THE OTHER SIDE
WITH A NEW HOPE FOR LIFE.
MANY OF THEM, UH, WITHIN A FEW MONTHS CAN ACTUALLY START
TO SEE SIGNIFICANT REDUCTIONS IN THEIR SEIZURES.
KAREN: I DID START TO JUST FEEL MORE IN CONTROL
OF MY ENVIRONMENT, OF MY BODY, OF MY MIND.
AND IT KIND OF BUILT MY CONFIDENCE BACK
BECAUSE I WASN'T HAVING THE SEIZURES LIKE I WAS BEFORE.
THEY WERE LESS AND LESS.
AND WHEN I DID HAVE THEM, I WASN'T AS FRIGHTENED ABOUT THEM
BECAUSE HE GAVE ME SOME REALLY GOOD TOOLS TO USE.
DR. LAFRANCE: I'M VERY EXCITED WHEN PATIENTS ARE ABLE
TO TAKE CONTROL OF THEIR SEIZURES
AND MAKE CHANGES IN THEIR LIVES.
AT THE OUTSET, I TELL THEM, "THIS WORK IS FOR YOU.
"IT'S NOT FOR ME, IT'S NOT FOR YOUR SPOUSE,
IT'S NOT FOR THE VA. THIS IS FOR YOU, YOURSELF."
KAREN: WELL, I GUESS WHAT I WOULD TELL PEOPLE
IS--IS IF YOU DO START HAVING SEIZURES,
DON'T BE AFRAID.
MAKE SURE YOU GO TO THE DOCTOR.
THE VA HAS EXCELLENT DOCTORS WHO CAN DIAGNOSE YOU
AND TREAT YOU, AND THEY'RE THERE FOR YOU AND HELPING YOU.
DAN: I THINK THE TENDENCY IS IF IT'S NOT PHYSICAL,
WE TEND TO STOP SEARCHING.
AND I WOULD ENCOURAGE THE SPOUSE OR THE COMPANION
OF SOMEBODY WHO IS SUFFERING THIS
TO PUSH THEM FORWARD.
DR. ALTALIB: THERE IS GOOD REASON TO BE HOPEFUL.
WE HAVE EXCELLENT TREATMENTS THAT ARE DEDICATED TO PEOPLE
WITH PSYCHOGENIC NONEPILEPTIC SEIZURES,
WHICH PEOPLE RESPOND TO AND BECOME SEIZURE FREE.
DR. LAFRANCE: AND WHEN PEOPLE HAVE NOT ONLY IMPROVEMENT OF SYMPTOMS,
BUT ALSO WHOLENESS IN THEIR OWN LIVES,
THAT GIVES ME GREAT, GREAT PLEASURE.
AND TO KNOW THAT WE'RE HOPEFULLY EQUIPPING PHYSICIANS
TO BE ABLE TO ENGAGE THIS CHALLENGING POPULATION,
AND ALSO EMPOWERING PATIENTS AND THEIR FAMILY MEMBERS
TO ACTUALLY LIVE THEIR LIVES AGAIN, THAT BRINGS ME GREAT JOY.
KAREN: IT'S SO WORTH IT. I AM SO HAPPY
THAT I HAD DR. LAFRANCE.
I MEAN, I THINK IT'S PRETTY AMAZING
THAT I WAS LIVING IN A PLACE
WHERE THERE WAS A NEUROPSYCHIATRIST
WHO WAS RESEARCHING AND LEARNING AND TRYING TO HELP VETERANS.
UH, FOR ME, THAT WAS A GODSEND.