Psychogenic nonepileptic seizures, previously known as pseudoseizures, usually have a psychological cause, such as severe mental stress. However, they do not involve changes to electrical impulses in the brain.

The symptoms of PNES are similar to those of epilepsy, but they are not the same condition, and the cause is different. Treatment to manage epilepsy is unlikely to be effective for those with PNES, but cognitive behavioral therapy (CBT) may help, according to the National Institute for Neurological Disorders and Stroke (NINDS).

In the past, people referred to pseudoseizures. However, the use of “pseudo” can imply that a person is pretending to have a seizure, which is not the case. For this reason, the preferred term is now psychogenic nonepileptic seizures (PNES). A doctor may also refer to them as psychogenic nonepileptic episodes (EPEE). We will use the term PNES throughout this article.

In this article, learn more about the causes and symptoms of PNES. It will also explore treatment options and outlook.

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A PNES is a type of nonepileptic seizure that results from psychological conditions rather than changes in brain function.

There are many types of seizures, but the two main categories are epileptic and nonepileptic.

A person who experiences epileptic seizures has epilepsy. Typical epileptic seizures occur when an electrical disturbance in the brain’s nerve cells causes a person to lose control of their body. Their muscles may jerk or seize up uncontrollably, and they may also lose consciousness.

Nonepileptic seizures occur in individuals who do not have epilepsy. One cause of nonepileptic seizures is PNES, which stems from a psychological or psychiatric cause. It does not involve changes in electrical impulses in the brain.

According to the advocacy group Epilepsy Foundation, around 20–30% of people who attend epilepsy centers for intractable seizures — seizures that are difficult to manage — have PNES. In the general population, the group suggests PNES may affect 2–33 people in every 100,000.

A PNES is different from an epileptic seizure, but their symptoms can be similar.

Symptoms may include:

  • suddenly becoming unresponsive
  • changes in consciousness
  • shaking movements
  • pelvic thrusting or bicycling movements
  • shaking the head from side to side
  • closing the eyes
  • closing or clenching the mouth
  • staring spells

Some signs may suggest that a person is experiencing PNES rather than epilepsy. They include:

  • wildly thrashing
  • side-to-side head movements
  • stuttering or shouting phrases
  • closing the mouth and eyes and resisting opening them during the seizure
  • responding to or being startled at a loud noise or other stimuli
  • a lack of drowsiness after an episode

In addition, a person who has experienced a PNES may not become drowsy after, but an individual who has an epileptic seizure will usually sleep after the event.

However, not all PNES events follow this pattern — some people experience only a sudden and brief loss of awareness without other symptoms.

People with PNES may also have symptoms of other mental health issues, such as anxiety.

PNES tends to affect people who have experienced trauma or who have a mental health condition or psychological stress. The stress may be due to a single traumatic event or an underlying chronic condition.

Experts refer to PNES as a conversion disorder, which means the person is unaware of what is happening and is not consciously pretending to have a seizure.

Possible underlying conditions include:

PNES and its accompanying conditions can have a severe impact on a person’s quality of life. Therefore, it is essential to receive a proper diagnosis and treatment.

Diagnosing PNES can be difficult. A doctor is not usually present to witness a seizure, and the symptoms the individual describes will often match those of an epileptic seizure.

Often, a healthcare professional will diagnose epilepsy and only consider PNES when epilepsy medications are not effective.

According to the NINDS, 5–20% of people who receive a diagnosis of epilepsy actually have PNES. Some people may have both.

If a person has frequent seizures that do not respond to epilepsy medication, a doctor may recommend staying in a specialty care unit. This stay usually involves a video and EEG that will monitor the person’s brain activity. By looking at the data from the video and EEG during a seizure, a healthcare professional can see if changes in a person’s electrical impulses play a role. They can also watch the video to observe any physical signs.

The doctor may also wish to rule out other conditions that can cause similar symptoms, such as:

  • sleep disorders, such as narcolepsy
  • movement disorders, for example, Tourette’s syndrome
  • complex partial seizures
  • absence seizures
  • fainting
  • vertigo
  • irregular heartbeat, or arrhythmia

If a person has previously received a diagnosis of epilepsy and is using drugs to manage this, a doctor should ensure this individual stops taking them. These medications are unlikely to help and could be harmful if a person does not need them.

A team of psychologists, psychiatrists, and neurologists may work together to form a correct diagnosis and suitable treatment.

Treatment for PNES will often focus on managing the symptoms of any mental health conditions or other stress factors. Counselling and CBT are options that may help.

PNES can be challenging to treat if the person is unaware of how the seizures affect them. Often, the only way to know this is through family or friends.

A psychiatrist will usually carry out a formal assessment to help determine the source of the trauma, disorder, or stress. They can then recommend treatment specific to the underlying condition.

There is no direct way to prevent PNES, but addressing any mental health concerns may help prevent them.

Anyone who experiences trauma may benefit from early counseling or therapy to prevent complications from occurring. Techniques may include talking about the event, relaxation practices, thought exercises, or other therapies.

Anyone who is experiencing seizures and finds that epilepsy medication does not help should speak with a doctor. If the symptoms are due to PNES, they may respond to alternative treatment approaches.

According to some research, learning about and accepting the diagnosis may help reduce PNES symptoms. Some people stop having seizures as soon as they receive the diagnosis following the video and EEG methods, and they do not experience further seizures. One older study states that 16% of people no longer have seizures 6 months after their diagnosis. However, more research from 2013 suggests that 66–87% of individuals with PNES may continue to experience them.

In general, addressing any underlying anxiety or other mental health conditions may help manage the condition and reduce the chance of seizures in the long term.

A person with PNES experiences seizures that are not due to epilepsy. Changes to electrical impulses in the brain do not play a role, but a past trauma, anxiety, or a history of abuse may be the underlying cause.

As PNES can appear similar to epilepsy, a doctor may at first prescribe drugs to manage epilepsy. However, these are unlikely to help. Once a person has a correct diagnosis, they may benefit from counseling, CBT, and treatment for related disorders, such as anxiety.