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Psychogenic Non-Epileptic Seizures (PNES)

Functional Seizure-Like Events Without Epileptiform Activity

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Nöroloji department. Book Appointment →

What is Psychogenic Non-Epileptic Seizures (PNES)?

Psychogenic non-epileptic seizures (PNES), also called dissociative seizures or functional seizures, are paroxysmal events resembling epileptic seizures but lacking the characteristic electroencephalographic correlates.

Subtype of functional neurological disorder (FND); not feigned (factitious or malingering excluded).

Prevalence: 2-33 per 100,000; female-to-male ratio 3:1; peak age 20-40 years.

Co-occurrence with epilepsy: 5-50% (mixed disorder).

Pathophysiology: dissociation, altered top-down attention, abnormal sense of agency, dysregulated emotional processing networks.

Misdiagnosis common: average delay to correct diagnosis 7-9 years; significant healthcare cost burden.

Distinct from organic non-epileptic events (syncope, sleep disorders, migraine).

Symptoms

Convulsive PNES: asymmetric thrashing, side-to-side head movement, pelvic thrusting, opisthotonos (arched back), eyes typically closed, prolonged duration (often 5-30+ minutes).
Atonic PNES: sudden falls without tone loss documented, retained awareness afterward.
Behavioral arrest PNES: staring, unresponsiveness, no postictal confusion.
Variable, inconsistent semiology between episodes.
Suggestibility: events precipitated by stress, emotional triggers, environmental cues.
Postictal recovery: often rapid (minutes), no postictal confusion or amnesia.
Eyes closed during convulsive episodes (epilepsy: eyes typically open).
Tongue tip biting (vs lateral biting in epilepsy).
Memory of event sometimes preserved.
Frequent (multiple times daily to weekly), often refractory to antiepileptics.
May witness in clinic, easier to capture for video-EEG.

Risk Factors

Female sex.
Younger to middle age (peak 20-40 years).
Childhood adversity (sexual, physical, emotional abuse, neglect).
PTSD or trauma history.
Comorbid psychiatric conditions: depression, anxiety, dissociation, personality disorders.
Comorbid epilepsy.
Other functional neurological symptoms.
Healthcare worker (occupational exposure).
Previous head injury, major medical illness.
Family history of FND or psychiatric illness.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • New-onset seizure-like events in adult.
  • Treatment-resistant 'epilepsy' on multiple antiepileptics.
  • Atypical seizure features (asymmetric movements, eyes closed, prolonged events).
  • Frequent psychiatric symptoms with seizure events.
  • Failed to find epileptiform activity on outpatient EEG.
  • History of trauma with new neurological symptoms.
  • Multiple unexplained neurological complaints.

Treatment Methods

01
Diagnostic gold standard: video-EEG monitoring capturing typical event with no epileptiform activity.
02
Outpatient EEG: often inadequate (interictal frequency low in PNES).
03
Inpatient long-term video-EEG monitoring: 1-7 days; safer if events captured under controlled medication discontinuation.
04
Provocation techniques: hyperventilation, photic stimulation, suggestion (controversial, ethical concerns).
05
Neuropsychological testing: cognitive function, dissociation, trauma assessment.
06
Diagnostic communication: critical step; clear, supportive explanation; avoid stigmatizing terminology.
07
Patient education: PNES are real and treatable; brain-mind connection; remove blame.
08
Discontinuation of antiepileptic drugs (gradually, watching for withdrawal seizures).
09
Multidisciplinary treatment:
10
Cognitive behavioral therapy (CBT) for PNES: structured 12-session program, proven efficacy.
11
Trauma-focused therapy: EMDR, prolonged exposure for PTSD.
12
Psychiatric management: SSRIs/SNRIs for comorbid depression/anxiety.
13
Family education and support.
14
Physical therapy for associated FND symptoms.
15
Specialized PNES clinics: best outcomes with integrated care.
16
Outcomes: 50-60% seizure freedom or marked reduction with appropriate treatment within 1-2 years.
17
Prognostic factors: shorter duration, motivation, treatment engagement, absence of severe psychiatric comorbidity, no concurrent epilepsy.
18
Relapse risk: 30-40%; long-term follow-up needed.

Which Department to Visit?

You can visit our Nöroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.