Psychogenic Nonepileptic Seizures (PNES) Overview

Medically Reviewed By Yalda Safai, MD, MPH
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Psychogenic nonepileptic seizures can occur after an emotional or stressful event. Unlike epilepsy, PNES isn’t a result of abnormal electrical brain activity. Clinicians used to refer to PNES as “pseudoseizures,” but the term is outdated and rarely used. PNES are real and involuntary and can impact health and quality of life. Clinicians also call them “psychogenic nonepileptic episodes.”

PNES are similar to epileptic seizures. However, PNES and epileptic seizures are distinct conditions with different causes and treatment approaches.

This article discusses the symptoms, causes, and treatment of PNES. It also discusses the diagnosis, prevention, and outlook for the condition.

Symptoms

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Although PNES aren’t the same as epileptic seizures, the symptoms are similar, such as:

  • changes in consciousness or alertness
  • lack of responsiveness
  • uncontrolled movement or noises, including:
    • shaking
    • pelvic thrusting or bicycling movements of the legs
    • abnormal postures
    • closing or opening the eyes or mouth
    • staring

Identifying PNES seizures vs. epileptic seizures

Symptoms that a person may be experiencing PNES can include:

  • losing and regaining consciousness
  • tightly closed eyes that resist opening
  • side-to-side head movements
  • wild thrashing
  • shouting or stuttering verbal phrases
  • possible lack of confusion or drowsiness after a PNES seizure
  • startling or responding when hearing a loud noise or other similarly startling input during a PNES seizure

People with PNES also frequently have a history of psychological conditions or have experienced factors such as:

Researchers from a 2022 overview note that while these symptoms may help indicate PNES in many cases, there are exceptions.

Someone with PNES may not experience some of these symptoms. Someone with epilepsy may occasionally experience them.

Also, someone who experiences epileptic seizures may experience a psychiatric condition.

Causes

Researchers believe that PNES has a psychiatric origin as part of a conversion disorder. A conversion disorder is when nervous system symptoms occur without any clear explanation or link to a physical illness or injury. Instead, PNES may be part of the brain’s response to emotional or physical distress.

Clinicians are still unsure what causes one person to develop PNES and another not to and how exactly the seizures occur. However, PNES may occur as part of neurological changes and psychiatric processes such as:

  • emotional processing and regulation
  • sensory and motor response
  • thought control
  • nerve function

As a result, PNES tends to develop in people with a history of psychiatric conditions or those who have experienced trauma.

This differs from epileptic seizures, which occur due to abnormal electrical brain activity. Still, someone can experience both epilepsy and PNES.

It is important to note that PNES are not voluntary or purposeful. People with PNES cannot control their seizures, and their symptoms are not faked.

Learn more about what causes different kinds of seizures.

Risk factors

Specific factors may increase the likelihood of someone developing PNES, such as a history of sexual or physical abuse or epilepsy.

However, not everyone who experiences these factors will develop PNES. Also, not everyone with PNES experiences these factors.

Diagnosis

Due to its similarity to other seizure conditions, people with PNES commonly are misdiagnosed, which may affect their access to treatment and support.

Some distinctive symptoms may help identify PNES, so observation can be useful in diagnosing PNES. Doctors may ask about symptoms or ask someone who witnessed a seizure to describe the PNES if you were unaware.

A doctor will also ask about your psychiatric and medical history. They may order diagnostic tests to rule out other conditions.

Other diagnostic methods may include:

  • video-EEG monitoring
  • EKG monitoring
  • imaging scans, such as MRI or CT scans
  • blood tests

Treatment

There is no specific treatment for PNES. Treatment approaches focus on addressing any underlying psychiatric condition and stress management. The treatments will be specific to you, your symptoms, and your condition.

Examples of treatments include:

  • medication to treat underlying conditions, such as antidepressants for depression
  • cognitive behavioral therapies, such as retraining and control therapy (ReAct)
  • mindfulness-based therapy
  • counseling

Antiepileptic medications are not effective in treating PNES. Excess or inappropriate use of antiseizure medications may lead to PNES in people with epilepsy and other health complications for anyone.

Supporting people with PNES

Due to misunderstandings, some people incorrectly believe that people with PNES pretend to have seizures or can control their seizures and health condition.

This may lead to some people with PNES reporting they feel accused of faking their condition. This can also lead to stigma when accessing care and impair their quality of life.

It’s vital for those supporting people with PNES to acknowledge the condition and the impact it may have.

Prevention

It may not be possible to prevent PNES from developing. However, following your treatment plan after diagnosis may help reduce the frequency of seizures.

Also, managing stress, treating psychiatric conditions, and avoiding sources of stress as much as possible may help address risk factors associated with the development of PNES.

Outlook

The treatment of underlying psychiatric conditions and additional support approaches may help decrease the frequency of PNES and improve quality of life.

Also, multiple research sources suggest that even understanding and accepting a diagnosis of PNES may help some people with managing and reducing PNES symptoms.

For example, a 2020 study suggests that more than 80% of people will experience a reduction or complete stop in PNES immediately after an accurate diagnosis. Others experience improvements in the months afterward.

Can you die from PNES seizures?

It is possible to die from PNES.

A 2020 study suggests that people with PNES have a death rate of 2.6 times higher than the general population. Yet this rate includes death from many complications, such as accidental poisoning with medication.

With care and treatment, some complications are preventable. Also worth noting is that the increase in this number still presents a relatively low risk.

In addition, treatment can be effective in managing the condition and reducing the frequency of seizures, lowering the risk of complications. Research also continues into additional treatment and support options.

Learn more about how seizures relate to the risk of death.

Summary

Psychogenic nonepileptic seizures (PNES) occur due to psychiatric distress. PNES differ from epileptic seizures as they are not the result of electrical brain activity.

Distinctive symptoms of PNES include uncontrolled thrashing, shouting verbal phrases, or responding to other stimuli during a seizure. However, PNES also has symptoms similar to epilepsy.

Treatment for PNES includes addressing underlying psychiatric conditions, cognitive behavioral therapy, and counseling. While PNES can cause significant impacts on health and even, in some cases, be life threatening, treatment can improve the condition.

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Medical Reviewer: Yalda Safai, MD, MPH
Last Review Date: 2022 Oct 28
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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