Neuropsychology - The Non-Epileptic Attack Disorder (NEAD) Service

Other names with the same meaning: Functional Seizures, Dissociative Seizures, Pseudoseizures, Psychogenic Seizures

Overview

This leaflet provides information about the NEAD Service within the Department of Clinical Neuropsychology at Salford Royal Hospital. It explains what to expect from our service and the type of support available to you.

What is NEAD?

NEAD episodes are a temporary loss of control and/or awareness of the mind and body. Unlike epileptic seizures, these episodes are not caused by abnormal electrical activity in the brain. Instead, they result from a build-up of physical and/or emotional stress within the nervous system.

A common way to explain NEAD episodes is through the “computer hardware vs. software” analogy.

The brain is like a computer: its physical structures (such as neurons and brain tissue) are the hardware, and its communication with the rest of the body is the software. NEAD is caused by a software problem or “glitch,” which leads to involuntary symptoms like seizures - even though there’s no damage to the brain itself. Just like a computer, the system may crash or behave unpredictably while the physical parts remain intact. Treatment therefore focuses on retraining the brain’s software.

What is the Nervous System?

The nervous system is the part of the body that controls how we move, feel and respond to the world around us. It includes the brain, spinal cord, and nerves that send messages all around the body. It helps us do everything from walking and talking to feeling emotions and staying safe.

When someone experiences NEAD, the nervous system is still working, but it can become overloaded by stress, strong emotions, or difficult past experiences. When this happens, the body reacts as if it’s in threat or “danger”, even when it’s not. This can lead to a temporary loss of control, like blacking out, shaking, or not being able to respond. Understanding the nervous system helps us see that these seizures are very real.

NEAD can affect anyone but usually happens when people have been, or are going through, difficult experiences. These include:

• Physical stressors (e.g., pain, illness, injury, fatigue)
• Emotional stressors (e.g. worries, anxiety, mental health problems, uncomfortable memories, grief)
• Life stressors (work, financial or relationship difficulties)

These episodes are the body’s natural response to stress or threat. They result from a miscommunication between the brain and body due to built-up physical and emotional pressure. While distressing, NEAD is treatable with appropriate strategies and support.

The NEAD Service

Our team of specialist clinicians provide support and guidance for individuals experiencing NEAD. We focus on:
•    Helping you understand your condition
•    Identifying the triggers, warning signs and factors maintaining your NEAD episodes
•    Management strategies to calm the nervous system and reduce symptoms. With time, this can hopefully lead to reduced frequency and intensity of episodes

Important: Seeking neuropsychological support does not mean you have a mental illness or that your seizures are "all in your head." Psychological therapy is recommended because NEAD arises from the complex connection between the mind and body.

First Steps

Once you have been referred by your health professional, you will be added to our waiting list. We will contact you via telephone or letter to invite you to an initial assessment appointment, so we can discuss your experience of NEAD and treatment options. This may be conducted in person or remotely (via telephone/video), depending on your preference and availability. During the appointment, we will:

• Discuss your seizures and their impact on your life
• Provide an opportunity for you to ask questions about our service and what we can offer
• Discuss our NEAD group and remote NEAD intervention course

Before your first appointment, you might receive some questionnaires by text message. Please try to complete these before your appointment. If you need any help with them, just
 
let us know - we will be happy to support you during your first session.

NEAD Intervention Course (remote)

Our NEAD Guided Course is designed to help individuals better understand NEAD and learn practical strategies for managing symptoms.

This guided course offers:

• Four sessions of educational videos helping you to understand your experience of NEAD
• Step-by-step techniques for symptom management
• Short weekly telephone review appointments following your independent learning each week. You will receive a call from someone within the team to discuss the content, ask questions and reflect on challenges

NEAD Intervention Group (Face-to-Face)

Our NEAD Group offers an interactive, in-person experience for individuals to share experiences and learn more about NEAD.

The sessions include:

• Education about NEAD episodes and its various causes
• Practical strategies for symptom management
• Opportunities to practice strategies
• Group discussions with others who experience NEAD
• Opportunities for reflection and support

The group includes three weekly sessions (2 hours) and one final review session a month later.

We have received some really positive patient feedback about these interventions:

Patient Feedback

• “I know more now than what I did before. I have just got more of an understanding of what is going on for me”
• “I found the course extremely helpful, finding out that NEAD is a recognised condition and that I am not the only person in the world with it"
• “The videos with the practical exercises were really helpful and I liked being able to go back and revisit them…I also thought that the weekly calls with the therapist were essential as being able to talk through the connections between the learning, and what you are actually experiencing, helps bring everything to life”
• “I liked meeting other people with the same condition… Sharing experiences and advice”

If you would like to take part in either the NEAD Guided Course (remote) or the NEAD Group (Face-to-Face) whilst you are on our waiting list, please contact our admin team using the contact details below, stating your preferred option.

What will happen after the course or group?

Most individuals find that completing the course or group provides them with the necessary tools needed to manage NEAD episodes. However, if further support is required, we offer:

• A review session (usually within 4 weeks) to assess your progress, reflect on what you have learned, explore any ongoing difficulties, and consider next steps for support
• The next step might be individual talking therapy (via video, phone or face-to-face)
• We may also consider referring you to other specialist services that we feel will better meet your needs. This may include physiotherapy; community talking therapies; local available options to support your wellbeing

What Happens Next?

We look forward to welcoming you into our service. It is natural to feel uncertain or nervous before attending, but our team is here to support you every step of the way. If you decide that you no longer need or want support, please let us know so that we can offer your place to someone else.

Frequently Asked Questions

Do I have to attend?

You have been referred because therapeutic support is the recommended treatment for NEAD. However, attending is your choice. It can be helpful to keep an open mind and come along to find out more; it is OK to have a lot of questions or decide you don't wish to have any further support.

Will I be given medication, scans or tests?

No, the NEAD Service does not prescribe medication or conduct medical tests. If you have any concerns about your physical health, please consult your GP.

Can I bring someone with me?

Yes, you may bring someone to your first appointment if you feel more comfortable. However, it is important that you feel able to talk freely in front of them. If you prefer, you are welcome to invite someone to wait for you in our reception area. For future sessions, we usually recommend attending alone.

Will my information be kept confidential?

Yes, information shared during appointments is kept private. We can decide together what to share with the rest of the team involved in your care, such as your GP and Neurologist. However, in rare cases where safety is a concern (for you or others), we may need to share information with relevant professionals.

Your clinician will also keep notes about your appointments. If these are written down, they will be stored securely in the Neuropsychology Department. Electronic notes are also kept safe and can only be accessed by staff within the department. To make sure you receive the best possible care, your clinician may also talk about the work they are doing with you in a confidential meeting with a senior colleague.

What are the treatment options?

Following your assessment, your clinician will discuss whether you would benefit from treatment with the NEAD Service. For most individuals, the first stage of treatment is attending one of our structured courses discussed above. In some cases, your therapist may decide that individual therapy sessions are more suited to your needs at this stage.

Contact Information

For more details about our service, including useful resources, please visit our website:
http://www.manchesterneurosciences.com/departments/ neuropsychology/nead

If you have any questions or concerns, please contact us at:

reftoneuropsych@nca.nhs.uk or 0161 206 4694
Department of Clinical Neuropsychology Clinical Sciences Building
Salford Royal Hospital
Northern Care Alliance NHS Foundation Trust