Can a person experience seizures that resemble epileptic seizures, even though they are not caused by abnormal electrical activity in the brain? This condition is known as psychogenic non-epileptic seizures (PNES), also called functional seizures. It is a real medical condition that can affect a patient’s psychological, physical, and social well-being, raising many questions and concerns for both the patient and their family.These seizures do not mean that the patient is pretending to be ill or deliberately causing the symptoms. Instead, they are a genuine condition that requires careful understanding, specialized diagnosis, and appropriate care.In this article from Dalili Medical, we will explore the main causes and symptoms of psychogenic non-epileptic seizures, how to distinguish them from epileptic seizures, and the available diagnostic and treatment options. We will also discuss the role of psychotherapy in improving the condition, the expected recovery timeline, and the factors that can help patients return to their daily lives and achieve a better quality of life.

1. What Are Psychogenic Non-Epileptic Seizures (PNES)?

Psychogenic non-epileptic seizures (PNES), also known as functional seizures or dissociative seizures, are episodes that may involve involuntary movements, body shaking, or temporary loss of responsiveness. These episodes differ from epileptic seizures because they are not caused by the abnormal electrical discharges typically associated with epilepsy. This condition does not mean that the patient is deliberately producing symptoms or pretending to be ill.

2. Is PNES Considered a Psychological Disorder?

Functional seizures are classified as a type of functional neurological disorder (FND). Their development may involve a combination of psychological, physical, and social factors. Although some cases may be associated with stress, psychological trauma, or emotional difficulties, this does not apply to every patient.

A diagnosis of functional seizures does not necessarily mean that the person has another mental health disorder, nor does it indicate that the symptoms are intentional or fabricated.

3. What Causes Psychogenic Non-Epileptic Seizures?

There is no single cause that explains functional seizures in every patient. Instead, they may develop through an interaction of several factors, including:

• Ongoing psychological stress: Severe or persistent life stressors may contribute to the onset or worsening of symptoms in some individuals.

• Traumatic experiences and psychological trauma: In some patients, seizures may be associated with previous distressing experiences or highly impactful emotional events.

• Anxiety and depression: Functional seizures may coexist with anxiety or depressive disorders, which can make managing symptoms more challenging.

• Altered processing of neurological and emotional signals: The condition may involve changes in how the brain processes sensory, motor, and emotional information, resulting in genuine symptoms without the abnormal electrical discharges characteristic of epileptic seizures.

4. What Are the Symptoms of PNES?

The symptoms of functional seizures vary from person to person and may resemble those of epileptic seizures. Common symptoms include:

• Shaking of the limbs or body: The patient may experience involuntary shaking movements of varying intensity.

• Repeated involuntary movements: These may appear as repetitive movements of the arms, legs, or other parts of the body.

• Reduced or temporarily lost responsiveness: The patient may appear unresponsive to their surroundings during an episode.

• Feelings of detachment from oneself or the surroundings: The person may feel disconnected from their body or experience a sense that their surroundings are unreal.

• Difficulty speaking or moving: Some patients may experience temporary difficulty speaking or moving certain parts of their body.

It is important to note that symptoms differ among patients, and the appearance of a seizure alone cannot confirm the diagnosis. A specialized medical evaluation is necessary to distinguish functional seizures from epilepsy and other conditions that may cause similar symptoms.

5. How Can PNES Be Distinguished from Epileptic Seizures?

Although functional seizures and epileptic seizures may appear similar, they differ in the neurological mechanisms responsible for them. Epileptic seizures result from abnormal electrical activity in the brain, whereas functional seizures are not caused by these types of electrical discharges.

Distinguishing between the two conditions relies on several medical assessments, including:

• Medical history: Gathering detailed information about the nature, frequency, duration, and associated symptoms of the episodes.

• Medical and neurological examination: Assessing the patient's overall condition and looking for signs that may help identify the underlying cause.

• Video electroencephalography (Video-EEG): This test records the patient's behavior during a seizure while simultaneously monitoring the brain's electrical activity. It is one of the most important investigations when distinguishing between functional and epileptic seizures.

It is important to understand that a normal EEG between seizures does not definitively rule out epilepsy. Additionally, some individuals may have both epilepsy and functional seizures. Therefore, the diagnosis should be based on a comprehensive assessment by a neurologist.

6. Are Psychogenic Non-Epileptic Seizures Dangerous?

Functional seizures can affect a patient's life to varying degrees, particularly when episodes occur frequently or interfere with daily activities. Potential effects include:

• Falls or injuries during an episode.

• Difficulty continuing education, working, or participating in social activities.

• Anxiety or fear about future episodes.

• Reduced quality of life due to symptoms or misunderstandings about the condition among family members and others.

Although functional seizures are not caused by the abnormal electrical discharges characteristic of epileptic seizures, they still require appropriate diagnosis and treatment. Urgent medical evaluation is important if a seizure occurs for the first time, symptoms differ from the person's usual episodes, a serious injury occurs, or the person has difficulty breathing. A new seizure-like episode should never automatically be assumed to be a functional seizure.

7. Can Psychogenic Non-Epileptic Seizures Be Cured?

Functional seizures can improve significantly in some patients and may stop completely in certain cases, while others may continue to experience episodes to varying degrees. Recovery outcomes differ from person to person and depend on several factors, including:

• Early and accurate diagnosis: Understanding the nature of the seizures and confirming the diagnosis helps guide appropriate treatment.

• Adherence to the treatment plan: Consistent participation in psychological therapy and regular medical follow-up may help improve symptoms.

• Treatment of coexisting conditions: Conditions such as anxiety, depression, or post-traumatic stress disorder (PTSD) should be addressed when present.

• Family and social support: A safe, understanding, and supportive environment can help reduce stress and improve coping skills.

• Duration and severity of symptoms: How long the seizures have been occurring and how frequently they happen may influence recovery, although these factors do not determine the outcome with certainty.

8. What Is the Treatment for Psychogenic Non-Epileptic Seizures?

Treatment for psychogenic non-epileptic seizures, medically known as functional seizures, depends on understanding the condition and identifying the patient's individual needs. There is no single treatment plan that is suitable for everyone. The main goals are to reduce seizure frequency, improve the ability to manage symptoms, and help patients resume their daily activities.

Common treatment approaches include:

• Psychoeducation: Explaining the nature of functional seizures in a clear, reassuring, and scientifically accurate way, helping patients understand that their symptoms are real and are not caused by pretending to be ill.

• Cognitive behavioral therapy (CBT): Helping patients recognize thoughts, emotions, and behaviors associated with their symptoms and develop more effective coping strategies.

• Treatment of coexisting conditions: Patients may benefit from treatment for anxiety, depression, or PTSD if these conditions are diagnosed.

• Emotional regulation training: Learning stress-management skills, improving awareness of bodily sensations, and developing appropriate strategies for responding to symptoms.

• Family and social support: Educating family members about the condition helps create a supportive environment, avoid blame or accusations, and encourage patients to gradually resume their usual activities.

Treatment is ideally coordinated between a neurologist and a qualified mental health professional, based on the confirmed diagnosis and the patient's individual circumstances.

9. Are There Medications for Psychogenic Non-Epileptic Seizures?

There are currently no medications reliably established as a direct treatment for functional seizures themselves. However, a doctor may prescribe medication for coexisting conditions, such as depression or anxiety, when clinically appropriate.

Traditional anti-seizure medications are not considered a treatment for functional seizures alone because they do not target the underlying mechanism responsible for these episodes. However, patients who also have epileptic seizures may need to continue taking anti-seizure medication to manage their epilepsy.

Therefore, anti-seizure medications should never be stopped or adjusted without consulting a neurologist. The diagnosis must be carefully confirmed, and the possibility that both types of seizures occur in the same person must be considered.

10. Can Cognitive Behavioral Therapy Help Treat PNES?

Cognitive behavioral therapy (CBT) is one of the psychological approaches that may help people experiencing functional seizures. It aims to improve the patient's understanding of their symptoms, identify factors that may be associated with their occurrence, and develop skills for managing them more effectively.

This treatment may involve several components, including:

• Identifying and challenging negative thoughts that increase fear of seizures.

• Recognizing emotions and situations that may be associated with the onset of symptoms.

• Learning to manage stress and intense emotional reactions.

• Reducing avoidance of daily activities caused by fear of experiencing another seizure.

• Developing a plan for managing symptoms and improving quality of life.

Responses to treatment vary from person to person. Some patients may experience a reduction in seizure frequency or severity, while others may require additional interventions or a longer period of treatment. Complete cessation of seizures cannot be guaranteed for everyone.

11. Is Eye Movement Desensitization and Reprocessing (EMDR) Therapy Helpful?

Eye Movement Desensitization and Reprocessing (EMDR) is primarily used to treat post-traumatic stress disorder (PTSD). It may also be considered for some individuals with functional seizures who have experienced psychological trauma or distressing memories that require treatment.

This approach involves processing distressing memories through structured sessions conducted by a qualified therapist, using bilateral stimulation techniques such as guided eye movements.

However, scientific evidence supporting the effectiveness of EMDR in directly stopping functional seizures remains limited. Therefore, it is not considered a necessary treatment for every patient. Its suitability depends on a psychological assessment, medical history, and the individual needs of each patient.

12. Do Functional Seizures Occur Voluntarily?

No. Functional seizures are not deliberate acts of pretending or behaviors that patients consciously choose. They are genuine symptoms associated with a disturbance in nervous system functioning and may appear as involuntary movements or temporary changes in responsiveness and awareness.

Accusing patients of faking their symptoms or telling them to stop a seizure simply by making a conscious decision may increase their distress and feelings of isolation. It is therefore important to treat patients with respect and understanding and provide appropriate medical and psychological support.

13. What Should I Do If Someone Has a Functional Seizure in Front of Me?

Managing a seizure requires prioritizing the person's safety and monitoring their condition without automatically assuming that every episode resembling previous seizures is functional. The following guidelines may help:

• Stay calm: Speak to the person in a calm voice and move furniture, sharp objects, and other potential hazards away from them.

• Protect the person from injury: Help them remain in a safe place. Do not restrain their movements or force them to stand.

• Do not put anything in their mouth: Never insert your fingers or any object into their mouth. Do not give them food, drinks, or oral medication during the episode.

• Monitor the duration and breathing: Record when the episode starts and ends, and watch for any unusual changes.

• Seek medical assistance when necessary: Call emergency services if it is the person's first seizure-like episode, if it lasts five minutes or longer, if episodes recur without the person regaining their usual responsiveness, or if a serious injury or breathing difficulty occurs.

If the person has already been diagnosed with functional seizures, it is helpful to follow the seizure management plan provided by their doctor. However, urgent medical assessment is necessary if new symptoms develop or an episode differs from the person's usual pattern.

14. Can Epilepsy and Functional Seizures Occur in the Same Person?

Yes. A person can have both epileptic seizures and functional seizures. This can make diagnosis more complicated because some episodes may result from abnormal electrical activity in the brain, while others are functional.

Distinguishing between these episodes requires specialized medical assessment and may involve recording seizures using video electroencephalography (Video-EEG). Identifying the type of seizure is important for selecting appropriate treatment and avoiding the unnecessary discontinuation or use of medication.

15. Do Psychogenic Non-Epileptic Seizures Affect Marital and Social Life?

Functional seizures may affect marital relationships, family life, and social interactions, particularly when episodes occur frequently or other people struggle to understand the condition. Patients may feel anxious about having a seizure in front of others or avoid going out and participating in social activities, which can affect their self-confidence and quality of life.

These effects may be reduced through psychoeducation, family support, learning symptom-management skills, and gradually returning to daily activities according to the patient's condition.

Open communication between patients and their families can also help clarify individual needs, reduce misunderstandings, and create a more supportive and secure environment.

16. Can Functional Seizures Return After Improvement?

Yes. Functional seizures may recur in some individuals after a period of improvement, while others maintain their progress for extended periods. Recurrence may sometimes be associated with increased psychological stress or changes in life circumstances, although episodes can also return without an obvious trigger.

To help manage the possibility of recurrence, patients are encouraged to:

• Continue medical follow-up according to their treatment plan.

• Practice the skills learned during psychological therapy.

• Maintain healthy sleep and rest habits.

• Establish a balanced daily routine and organize activities appropriately.

Regular follow-up and early attention to changes in symptoms can help patients manage recurrence and maintain their progress over time.

17. How Long Does Recovery from Pseudoseizures (Functional Seizures) Take?

The recovery period from pseudoseizures, medically known as functional seizures or dissociative seizures (PNES), varies from person to person. There is no fixed timeframe that guarantees the complete disappearance of seizures. The rate of improvement depends on several factors, including how long the symptoms have been present, how frequently seizures occur, the accuracy of the diagnosis, the effectiveness of treatment, and the presence of other coexisting conditions.

Some patients may notice gradual improvement during the first few weeks or months of treatment, while others may require several months or longer to achieve meaningful progress. Symptoms may persist in some patients despite receiving treatment, making it necessary to review and adjust the treatment plan according to their individual needs.

It is important to distinguish between two key concepts:

Duration of an individual seizure: A seizure may last from a few seconds to several minutes and may last longer in some cases. Therefore, prolonged or unusual seizures should be medically evaluated.

Recovery from the condition: This refers to the time needed to achieve improvements in seizure frequency or severity, regain the ability to perform daily activities, and improve overall quality of life. This process may take several months or longer.

How Long Does Treatment Take?

The duration of psychological treatment varies according to the patient's condition and individual needs. Some cognitive behavioral therapy (CBT) programs involve a specific number of sessions, while other cases may require a longer treatment program or additional therapeutic interventions.

Some programs may consist of 8–12 sessions, but this is not a fixed rule for all patients, and completing this number of sessions does not necessarily mean that the seizures will disappear completely. The aim of therapy is to help patients understand their symptoms, develop coping skills, and reduce the impact of the condition on their daily lives.

What Factors Help Recovery?

Several factors may contribute to better recovery outcomes, including:

• Early and accurate diagnosis: Helps ensure that appropriate treatment is started and prevents confusion between functional seizures and epileptic seizures.

• Adherence to psychological treatment: Allows patients to develop skills for managing symptoms and associated stress.

• Treatment of coexisting conditions: Such as anxiety, depression, or post-traumatic stress disorder (PTSD), when diagnosed.

• Family support: Understanding the nature of the condition can help reduce feelings of blame, guilt, and isolation.

• Ongoing medical follow-up: Allows progress to be assessed and the treatment plan to be adjusted when necessary.

What Causes Pseudoseizures (Functional Seizures)?

Functional seizures can develop through a combination of psychological, biological, and social factors. No single cause explains every case, and some patients may not identify a clear triggering event.

• Physical abuse: Experiences involving physical violence may be associated with the development of functional symptoms in some individuals.

• Sexual abuse: These experiences may have long-term psychological effects and can be associated with dissociative symptoms or functional seizures in some survivors.

• Childhood trauma: Such as neglect, violence, or exposure to distressing events during developmental years.

• Post-traumatic stress disorder (PTSD): Functional seizures may occur alongside symptoms related to traumatic memories or previous distressing experiences.

• Severe anxiety and psychological stress: Ongoing stress or intense emotions may contribute to the onset or worsening of seizures in some patients.

• Family and social problems: Such as recurrent conflicts, lack of social support, or difficult life circumstances.

• Financial difficulties or job loss: These circumstances may increase psychological stress, although they do not necessarily cause seizures.

• Difficulty managing emotions: Some individuals may struggle to regulate fear, anger, or sadness, which may coexist with functional symptoms.

• Coexisting mental health conditions: Functional seizures may occur alongside anxiety, depression, or other psychological disorders. However, having one of these conditions does not necessarily mean that a person will develop functional seizures.

• Mood disorders: Such as depression, which may affect emotional well-being and the ability to cope with stress.

• Certain personality disorders: Functional seizures may coexist with difficulties in emotional regulation or interpersonal relationships in some individuals. However, borderline personality disorder or any other personality disorder should not be considered a direct or inevitable cause of functional seizures.

• Attention-deficit/hyperactivity disorder (ADHD): ADHD may coexist with functional seizures in some patients, but it is not an established direct cause.

• Substance use: The use of certain substances or withdrawal from them may affect the nervous system and cause symptoms or seizures that require medical evaluation to distinguish them from functional seizures.

• Neurological and physical factors: Functional seizures may coexist with other neurological conditions, including epileptic seizures. Therefore, a thorough medical assessment is necessary to rule out other causes.

What Are the Symptoms of Pseudoseizures (Functional Seizures)?

1. Body Movements and Convulsions

Functional seizures may involve various involuntary movements, including:

• Shaking of the arms, legs, or other parts of the body.

• Repetitive movements that vary in intensity and pattern.

• Involuntary arching of the back or muscle tightening.

• Movements that continue for varying lengths of time from one person to another.

2. Changes in Awareness and Responsiveness

Functional seizures may be accompanied by changes in a person's response to their surroundings, including:

• Reduced or temporarily absent responses to speech or environmental stimuli.

• Forceful eye closure during some seizures.

• Feelings of detachment from oneself or one's surroundings.

• Difficulty speaking or communicating during a seizure.

• Gradual return of responsiveness in some patients.

3. Physical and Emotional Symptoms

Some patients may experience physical or emotional symptoms during or after a seizure, such as:

• Rapid breathing or shortness of breath.

• Heart palpitations or dizziness.

• Crying or intense fear.

• Fatigue or headaches after the seizure ends.

Diagnosing Pseudoseizures: What Tests Are Required?

1. Detailed Medical History

The doctor asks about the onset, duration, and frequency of seizures; possible triggers; associated symptoms; what happens after each episode; and the patient's medical and psychological history, including medications being used.

2. Seizure Description or Video Recording

Recording a typical seizure, if it can be done safely, may help the doctor evaluate the nature of the movements and the patient's responsiveness during the episode. However, a video alone is generally insufficient to confirm the diagnosis.

3. Video Electroencephalography (Video-EEG)

Video-EEG is one of the most important tests for confirming the diagnosis when it is available and appropriate for the patient's condition. It records video footage simultaneously with the brain's electrical activity, allowing the doctor to compare visible symptoms with electrical changes during a typical seizure.

The results must be interpreted in the context of the clinical presentation because some types of epileptic seizures may not be clearly visible on scalp EEG recordings.

4. Conventional Electroencephalography (EEG)

EEG helps identify signs of epileptic activity, but it cannot independently confirm functional seizures or rule out epilepsy. Some people with epilepsy may have normal EEG results.

5. Additional Tests When Needed

Depending on the symptoms and medical assessment, additional investigations may include:

• Blood tests.

• Electrocardiography (ECG).

• Blood pressure measurement.

• Brain magnetic resonance imaging (MRI).

These tests may help rule out fainting, heart rhythm disorders, metabolic disturbances, and other neurological or medical causes of seizure-like episodes.

Table Comparing Pseudoseizures (Functional Seizures) and Epileptic Seizures

The two conditions differ in the mechanisms that cause seizures, although some symptoms may overlap. Therefore, a diagnosis cannot be made based on a single sign or on the table alone.

Feature	Functional Seizures (PNES)	Epileptic Seizures
Underlying mechanism	A disorder of nervous system functioning that may involve a combination of psychological, social, and biological factors	Abnormal electrical activity in brain networks
Nature of movements	Movements may vary or occur intermittently, with changes in intensity and pattern during an episode	Movements may be convulsive or repetitive in a specific pattern; some seizures occur without obvious convulsions
Limb movements	Movements may change, stop, and then resume, depending on the seizure	Movements may follow a repetitive pattern depending on the seizure type
Eyes	May be tightly closed during some episodes	May be open or closed; this sign alone cannot distinguish between the two conditions
Awareness and responsiveness	Responsiveness or awareness may be affected to varying degrees	Awareness may be impaired, although it remains intact in some seizure types
Seizure duration	Duration may vary and episodes may be prolonged	Duration varies by seizure type; many convulsive seizures last approximately one to two minutes
After the seizure	Fatigue, headache, or confusion may occur	Drowsiness, confusion, headache, or muscle soreness may occur
EEG during the seizure	Typically does not show epileptic electrical activity explaining the recorded event	May show epileptic electrical activity, although some seizures are not clearly detected by scalp EEG
Treatment	Education about the condition and appropriate psychological or rehabilitative treatment, such as cognitive behavioral therapy for some patients	Antiseizure medications and, when appropriate, other treatment options
Can both conditions coexist?	Functional seizures can occur alongside epilepsy	A person can have both epilepsy and functional seizures

Treatment of Pseudoseizures with Medication

The key point: No antiseizure medication has been established as a direct treatment for functional seizures themselves. However, a doctor may prescribe medication for coexisting conditions, such as depression or anxiety disorders, when clinically indicated.

1. Which Medications May Be Used?

Medication category	Examples	When are they used?
Antidepressants	Sertraline, escitalopram	When depression or an anxiety disorder requiring medication has been diagnosed
Anti-anxiety medications	The doctor selects the appropriate medication based on the diagnosis	When an anxiety disorder requires pharmacological treatment, not simply because seizures occur
Antiseizure medications	Levetiracetam, valproate, lamotrigine	When the patient also has epilepsy or another medical condition that warrants their use

These medications are examples for educational purposes, not a prescription. The choice of medication, dosage, and treatment duration depends on the accurate diagnosis, associated symptoms, medical history, and other medications the patient is taking.

Some anxiety medications, particularly sedatives belonging to the benzodiazepine class, are not routinely used to treat functional seizures because of their risks of dependence and side effects. They may be used in specific circumstances at the treating physician's discretion.

Tips for Managing Pseudoseizures (Functional Seizures)

1. Understand the Nature of the Seizures

Learn about the difference between functional seizures and epileptic seizures, and discuss your diagnosis with a neurologist. Understanding the condition can help reduce fear and confusion and make participation in treatment more effective.

2. Follow Your Treatment Plan

Attend the psychological therapy or rehabilitation sessions recommended by your healthcare professional, and take prescribed medications for coexisting conditions, if any.

Do not stop antiseizure medications or change their dosages without consulting your doctor, especially if epilepsy may coexist with functional seizures.

3. Learn Relaxation and Grounding Techniques

Certain techniques may help you manage symptoms, including:

• Slow, controlled breathing.

• Sensory grounding techniques.

• Recognizing and managing emotions.

You can practice these skills with your therapist and use them when you notice warning signs before a seizure, if such signs occur in your case.

4. Maintain a Regular Lifestyle

• Get sufficient sleep and maintain a consistent sleep schedule.

• Eat balanced meals and drink water regularly.

• Engage in physical activity appropriate for your condition, consulting your doctor when necessary.

• Set aside time for rest and activities that help you feel stable.

• Avoid alcohol and recreational drugs, and discuss any substances or medications that may affect your symptoms with your doctor.

These habits support overall health but are not a standalone treatment for functional seizures.

5. Keep a Seizure Diary

Record the time and duration of each seizure, the symptoms that accompanied it, and what happened before and afterward, when possible.

This record may help you identify recurring patterns and monitor progress with your doctor, without assuming that every seizure has an obvious psychological trigger.

6. Do Not Blame Yourself

You may not be able to control when a seizure begins or stop it through willpower. This does not mean that you have a weak personality or are deliberately producing the symptoms.

Give yourself time, seek help when needed, and discuss your concerns with a healthcare professional rather than feeling guilty or ashamed.

Second: What Should You Do During a Seizure?

If a seizure begins, the priority is to keep the person safe.

1. Stay calm: You and those around you should avoid shouting or causing unnecessary alarm.

2. Make the area safe: Move sharp or hard objects away and help prevent falls or collisions.

3. Do not restrain movements: Do not forcibly hold the person's limbs or attempt to stop the movements.

4. Do not put anything in the mouth: Do not give water, food, or oral medication during the episode.

5. Monitor the duration and breathing: Time the seizure and watch for breathing difficulties or injuries.

6. Offer support afterward: Speak calmly, allow the person time to recover, and ask what they need.

Seek urgent medical assistance if this is the person's first seizure-like episode, if an episode lasts five minutes or longer, if seizures recur without recovery to the person's usual state, or if an injury or breathing difficulty occurs.

Do not assume that every new episode is a functional seizure, even if the person has previously been diagnosed with the condition.

Third: Advice for Family Members and Caregivers

Family members can play an important role in supporting recovery by following these recommendations:

• Respond with respect and understanding: Remember that functional seizures are real and involuntary. Avoid accusing the person of pretending or exaggerating.

• Provide a safe environment: Learn appropriate first aid and agree on a clear plan for responding to seizures.

• Avoid blame and pressure: Do not punish the person for having a seizure or demand that they stop it through willpower.

• Encourage treatment: Help the person attend appointments and follow the treatment plan without coercion or dismissing their concerns.

• Support independence: Encourage a gradual return to school, work, and social activities in accordance with the treatment plan.

• Communicate with the healthcare team: Share useful observations about the seizures while respecting the patient's privacy.