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Functional Seizures (PNES)

Functional Non-Epileptic Seizures (formerly known as PNES – Psychogenic Non-Epileptic Seizures) are seizure-like episodes involving altered behavior that closely resemble epileptic seizures. However, no structural or organic cause can be identified, and there is no corresponding electroencephalographic (EEG) activity during the event.

These episodes are not caused by abnormal electrical activity in the brain, but rather by an unconscious response to psychological stress or emotional conflict.

It is important to emphasize that individuals with PNES are not faking or consciously producing these events. The seizures occur without voluntary control, and patients are often distressed by them.

 

How Common Are Functional Non-Epileptic Seizures (PNES)?

Functional non-epileptic seizures affect approximately one in three patients evaluated at epilepsy centers for pharmacoresistant seizure disorders. Additionally, 15–20% of patients diagnosed with epilepsy also experience coexisting PNES. These seizures most commonly begin between the ages of 20 and 40, although they are also observed in children. Women are affected more frequently, and many patients have co-occurring psychiatric conditions such as depression, anxiety, or a history of self-harm.

 

What Do Functional Non-Epileptic Seizures Look Like?

Functional non-epileptic seizures can closely mimic a wide variety of epileptic seizures. They may involve:

  • Full-body convulsions
  • Jerking movements
  • Loss of consciousness with falls
  • Arching of the back
  • Tonic-clonic–like activity

Unlike typical epileptic seizures, PNES often last several minutes, and their features may change over the course of the episode. A common sign is side-to-side head shaking with closed eyes. These events usually occur in the presence of others and are often triggered by emotional stress.

What Causes Them?

PNES are typically a subconscious response to psychological stress or trauma. They may be linked to past traumatic experiences, such as abuse or loss of a loved one, chronic stress, recent illness or surgery; or underlying mental health conditions, such as anxiety, depression, or post-traumatic stress disorder (PTSD). PNES may appear immediately after a traumatic event, or they may develop years later, sometimes without an obvious triggering factor.

here is often a specific trigger before each event—this may be an external situation or an internal emotional response. However, many individuals are not consciously aware of the stress signals, which can make it difficult to connect the event to a specific cause.

Ironically, fear of having another seizure can itself act as a trigger.

Treatment

Anti-seizure medications are not effective for PNES. If you have previously been misdiagnosed with epilepsy, your doctor may recommend gradual withdrawal of antiepileptic drugs.

Effective management of PNES focuses on mental health care, including:

  • Psychological support and therapy
  • Identifying and addressing seizure triggers
  • Developing healthy coping strategies for stress

In some cases, your healthcare provider may recommend anti-anxiety medications (anxiolytics) or antidepressants, depending on your individual needs.

First Aid for Functional Non-Epileptic Seizures

First aid for PNES is similar to that for epileptic seizures:

 

  1. Keep the person safe by removing dangerous objects nearby. Only move them if absolutely necessary
  2. If they fall, place something soft under their head.
  3. Do not try to physically restrain the person.
  4. Stay with them until the episode resolves.

Do not administer rescue medications, as they are ineffective for non-epileptic seizures.

Driving and PNES

Driving eligibility for individuals with PNES is assessed on a case-by-case basis, depending on individual circumstances, frequency of episodes, and risk of impairment during driving.

Epilepsy