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As a neurologist who has had a lot of exposure to patients with seizures throughout my career, one of the most important conversations we have is explaining non-epileptic seizures (NES). These episodes can be just as frightening and disabling as epileptic seizures, yet they are often misunderstood. My goal is to help my patients and their families understand what NES are, why they happen, and how we can work together to treat them.

Note: The term "PNES" is largely no longer used in many clinical settings because the word "psychogenic" can be misconstrued by patients and families as implying the seizures are "fake" or "all in their head," undermining the reality and involuntary nature of the condition.

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What are non-epileptic seizures?

When you witness an episode, non-epileptic seizures look heartbreakingly similar to epileptic seizures, where a person might suddenly lose awareness, experience shaking or flailing movements, or fall. The crucial, defining difference lies in the brain's activity. In true epilepsy, seizures are caused by a chaotic, abnormal electrical storm in the brain. In NES, however, the EEG doesn’t show abnormal electrical discharge. Instead, the brain processes immense stress or emotional distress in a physical, involuntary manner.

Please understand that NES are involuntary. These seizures are not "faked," "put on," or a manipulative bid for attention. They are a genuine, physical manifestation that the brain and body are overloaded and crying out for help. They deserve our fullest compassion, deepest respect, and the very best medical attention, just like any other serious medical condition.

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How to differentiate NES and Epilepsy

Because the episodes present so similarly, distinguishing epilepsy from NES can be a lengthy and frustrating process. We know that many patients have spent years on anti-seizure medications that offered no relief, simply because the underlying cause was missed.

The most definitive and reliable way to get an accurate diagnosis is through Video EEG monitoring. This is a powerful test that simultaneously records brain activity and your physical behavior. If we capture a seizure on video and the EEG shows no corresponding electrical discharge, we can finally give you a confident diagnosis of non-epileptic seizures.

We always emphasize that the lack of electrical changes and the absence of an electrographic seizure does not mean we are powerless. On the contrary, it simply guides us to effective, tailored treatment strategies that truly work.

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What causes NES?

Every patient’s story is unique, and sometimes we’re unable to uncover the root cause. But common themes include past or ongoing trauma, increasing stress levels, and no therapeutic outlet, undiagnosed depression, anxiety, or PTSD. As neurologists, we think of NES as the brain’s profoundly protective, though ultimately unhelpful, way of channeling emotional pain and distress into a physical action.

We want patients and their loved ones to know that NES are not a sign of weakness or a fault in their character. These patients are not intentionally seeking attention. This is the body’s way of signalling that something is emotionally upsetting and needs to be addressed.

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How we treat non-epileptic seizures

Because these seizures are not electrical in origin, anti-seizure medications are simply not the answer. Our treatment focus shifts beautifully to nurturing the underlying causes and teaching the brain and body new, healthier, and safer ways to respond to distress.

Here is how we approach your care, together:

1. Validation: One of the most powerful healing moments in our practice is when we take the time to sit down with a patient and fully explain their diagnosis. To hear, "Your seizures are real, they are non-epileptic, and we have a path to treat them," often brings an immediate, profound sense of relief and hope.
2. Psychotherapy: Many patients find tremendous benefit in targeted therapy, most often Cognitive Behavioral Therapy (CBT). This approach helps us identify triggers, process past wounds (especially in trauma-focused therapies for PTSD), and build stronger, more resilient coping strategies.
3. A team-based approach: The most positive, lasting outcomes are born from a multidisciplinary team effort. At Neura, we reach out to specialists in psychology, psychiatry, and sometimes physical or occupational therapy. Because NES affects so many aspects of your well-being, working together to address both seizures and underlying conditions is paramount.
4. Treating co-existing conditions: If we identify conditions like depression, anxiety, or PTSD, supportive medications can be incredibly helpful. While they don't treat the NES directly, they stabilize your emotional foundation, making the overall journey toward recovery smoother and more achievable.
5. Support for patients and families: Education is the key that unlocks empathy. We strongly encourage patients and their families to learn everything they can about NES so they can respond with understanding, patience, and love, rather than frustration. Support groups and community resources are invaluable anchors for both patients and the dedicated people close to them.

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Non-epileptic seizures can be confusing and overwhelming, but they are real, serious, and treatable. At Neura, we treat your diagnosis with compassion, reach out to your care team, connect you with the right treatments, and support you every step of the way.

Book a visit today!

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