Functional Seizures (PNES): Symptoms, Diagnosis, and Treatment
Author: Angela Bogdanova · Published: October 12, 2026 · Editorial Policy
Research cluster: Somatic Symptom & Functional Disorders · Written by Artificial Sapiens
Functional seizures are involuntary episodes that resemble epileptic seizures but arise through a different clinical process. They can involve shaking, loss or alteration of awareness, changes in movement or speech, intense bodily sensations, or periods of apparent unresponsiveness. The experience and disruption are real. Diagnosis rests on a careful account of the events, examination, and appropriately interpreted clinical or video-electroencephalographic findings. A person can also have both functional and epileptic seizures. The 2026 American Academy of Neurology (AAN) practice guideline establishes a practical approach to diagnosis, communication, treatment, and continuing care.
Functional seizures are often called psychogenic nonepileptic seizures (PNES), dissociative seizures, or functional/dissociative seizures (FDS). In 2025, an International League Against Epilepsy (ILAE) task force proposed FDS as an internationally consistent term, while PNES remains widely used in clinical records and public searches. The name does not determine the diagnosis: the pattern of events, clinical evidence, and differential assessment do.
This article explains what these episodes can look like, how clinicians distinguish them from epilepsy and other conditions, what video EEG can and cannot establish, how treatment is selected, and how patients and families can manage safety and recovery. A first unexplained seizure-like event, a serious injury, breathing difficulty, or a new pattern of events requires appropriate medical assessment.
What Are Functional Seizures?
A functional seizure is a time-limited episode of altered movement, awareness, responsiveness, perception, or bodily control associated with functional neurological symptom mechanisms. The term 'functional' refers to a disturbance in the way neurological functions are generated or coordinated, rather than a conclusion that the episode was deliberate. Functional seizures are a recognized presentation within functional neurological disorder (FND). They are diagnosed by qualified clinicians using characteristic features and context-appropriate investigations. See the ILAE clinical definition and terminology proposal.
In epilepsy, seizures arise from abnormal, excessive or synchronous neuronal electrical activity. Functional seizures are not generated by that epileptic electrical activity. This distinction has direct consequences for testing and treatment: medications used to prevent epileptic seizures have no established role in treating functional seizures themselves, although they may remain necessary if epilepsy or another medical indication is present. The AAN guideline directs clinicians to evaluate for both conditions when appropriate.
The words 'psychogenic' and 'dissociative' appear in older records, research articles, and different diagnostic systems. They should not be interpreted as proof that a specific psychological stressor or traumatic experience caused a particular person's episode. Both biological and psychological processes can be relevant to a formulation, and the contribution of each must be assessed rather than assumed.
Are Functional Seizures Real?
Yes. Functional seizures are genuine events that may be frightening, exhausting, disabling, and dangerous because of falls, injuries, and disruption of awareness. Patients generally do not initiate or control them voluntarily. Their diagnosis does not imply deception, attention-seeking, or malingering. It also does not imply that every symptom occurring afterward is functional. The ILAE task force emphasizes a clinically grounded description that can be discussed respectfully with patients.
How Are Functional Seizures Classified?
In the American DSM-5-TR framework, seizure-type episodes can be described under functional neurological symptom disorder (conversion disorder), with attacks or seizures as the relevant symptom presentation. In ICD-11, closely related episodes fall within the dissociative neurological symptom disorder framework. Classification labels and coding arrangements therefore differ across systems; the DSM-5-TR wording and ICD-11 dissociative model should not be treated as identical categories. The American Psychiatric Association classification chapter and WHO ICD-11 clinical descriptions provide the respective primary frameworks.
Functional seizures, a broader diagnosis of FND, a dissociative disorder, a history of trauma, and epilepsy are different clinical concepts. One person may satisfy criteria for more than one condition, but none should be assigned automatically because the other is present.
Symptoms: What Do Functional Seizures Look and Feel Like?
Functional seizures vary widely. Some resemble generalized convulsive seizures: a person falls, shakes, stiffens, cries out, or becomes unresponsive. Others involve trembling, jerking of one or more limbs, changes in breathing, a sense of detachment, dizziness, a sudden inability to move or speak, or prolonged immobility. Eyes may be closed, apparent responsiveness may fluctuate, and some people retain partial awareness even when observers assume they are unconscious. These descriptions reflect possible clinical patterns, not a home diagnostic checklist. The ILAE terminology report describes both subjective and observable dimensions.
A person may describe an approaching wave of heat, pressure, tingling, palpitations, unreality, fear, or mental blankness. An episode may be followed by headache, muscle pain, fatigue, confusion about what happened, emotional distress, or a need to rest. Memories can be incomplete. Some people experience recognizable warning sensations; others have little or no warning. The form, duration, and frequency of episodes can change with time, and even one person may have more than one event type.
Clinical observations sometimes associated with functional convulsive events include prolonged or fluctuating movements, asynchronous limb activity, variable intensity, eye closure during apparent unresponsiveness, or moments of retained awareness. These features have diagnostic value only in combination with trained observation and the clinical context. They are neither universal features of functional seizures nor absolute exclusions of epilepsy. Clinicians consider the complete event rather than assigning a diagnosis from a photograph, short clip, isolated sign, or questionnaire. See the AAN recommendations.
Can a Functional Seizure Happen Without Visible Shaking?
Yes. Some episodes are primarily characterized by staring, immobility, altered awareness, reduced responsiveness, sensory changes, or a freeze-like state. Conversely, similar outward behavior can occur with focal epileptic seizures, syncope, migraine, sleep-related conditions, and metabolic disturbances. The absence of shaking does not reliably classify an episode as functional or epileptic.
How Long Do Functional Seizures Last?
Duration is variable, and some functional seizures last longer than many typical epileptic convulsions. Duration alone cannot identify the event mechanism. A prolonged or unfamiliar episode remains a safety issue until appropriately assessed. A person whose condition is already well characterized may receive an individualized emergency response plan from their specialist, but family members and bystanders should not infer from appearance alone that prolonged activity is harmless.
Functional Seizures Versus Epileptic Seizures
The central diagnostic distinction is the mechanism of the event. Epileptic seizures reflect epileptic brain electrical activity; functional seizures do not. Both may involve impaired awareness, falls, involuntary movement, and injury. A diagnosis based entirely on the presence of stress, a normal MRI, or a normal routine EEG is unsound. The NICE epilepsy diagnostic guidance explicitly states that EEG should not be used to exclude epilepsy.
Experienced clinicians examine the sequence of an event: what starts first, how movement evolves, whether responsiveness varies, what witnesses observed, whether the signs are consistent across episodes, what occurs afterward, and whether different event types have different patterns. Certain combinations of signs can support a functional diagnosis, especially when captured alongside physiological recording. Yet some focal epileptic seizures produce limited or inconspicuous scalp EEG changes. A specialist therefore interprets the recording with the video, semiology, and full neurological history, not the EEG trace in isolation.
Functional and epileptic seizures can coexist. Identifying a functional event does not erase a preexisting epilepsy diagnosis, and documenting epilepsy does not explain every future event as epileptic. Mixed presentations call for separate descriptions of each habitual spell, individualized medication decisions, and follow-up that accounts for both conditions. The 2026 AAN guideline specifically recommends assessment for co-occurring epilepsy.
Panic attacks, fainting, dissociative symptoms, and epileptic seizures can also overlap in sensations or appearance. Our separate article on panic attacks versus seizures addresses the panic-specific comparison. Functional seizures should remain the central clinical question in the present article.
How Clinicians Diagnose Functional Seizures
1. A Detailed Account of Typical Events
Evaluation begins with an attentive history from the patient and, when appropriate, witnesses. Clinicians ask about first onset, frequency, duration, preceding sensations, sleep and waking state, movements, responsiveness, memory, falls, injury, recovery, medications, cardiovascular symptoms, neurological history, previous seizures, and whether there are several distinct event types. A smartphone recording of a habitual episode can be helpful when obtained safely and respectfully. Recording should never delay first aid or require provoking an event. The AAN guideline recommends obtaining patient and witness information, including available smartphone videos.
2. Neurological Examination and Selective Testing
A neurologist or epilepsy specialist considers epileptic seizures, fainting and cardiac rhythm disorders, low blood sugar, medication or substance effects, sleep disorders, migraine phenomena, and other relevant explanations. Appropriate testing depends on history and examination. An electrocardiogram may be important after an apparent transient loss of consciousness; laboratory tests, imaging, or other monitoring may be indicated by the presentation. The NICE epilepsy guidance specifically includes clinical assessment, witness history, ECG, metabolic considerations, and selective EEG or imaging.
3. Video EEG and Capture of a Typical Event
Video electroencephalography (video EEG or vEEG) simultaneously records behavior and scalp electrical activity. When a typical seizure-like event is captured, the clinical behavior can be examined alongside the EEG for evidence of an epileptic correlate. Capturing a habitual functional event without an appropriate epileptic correlate, within an expert interpretation of its features and recording limitations, can provide a high level of diagnostic certainty. The ILAE staged diagnostic approach describes documented, clinically established, probable, and possible levels of certainty rather than requiring the same test pathway in every setting.
An uneventful recording is less informative than a recording that captures the person's usual event. Likewise, a normal interictal EEG between episodes does not prove PNES; many individuals with epilepsy have normal recordings between seizures. A brief routine EEG can miss epileptic abnormalities, and some epileptic events have poor scalp EEG visibility. If a person has two distinct seizure types, recording one type may leave the other unresolved. The AAN practice guideline advises vEEG of typical events where feasible when diagnostic uncertainty remains.
4. Clear Diagnostic Explanation and Review
The clinician should state the diagnosis, explain the evidence that supports it, name meaningful uncertainties, and give the patient time for questions. Where diagnostic confidence remains limited, recording an appropriate level of certainty supports honest care planning. A positive functional diagnosis allows treatment to begin, while new neurological findings or a substantial change in event pattern may justify renewed evaluation. The AAN guideline emphasizes a specific label, rationale, respectful communication, shared decisions, and continuity of care.
What Else Can Cause Seizure-Like Episodes?
The differential diagnosis is broader than epilepsy versus PNES. Vasovagal syncope, cardiac arrhythmia, orthostatic or autonomic disturbances, hypoglycemia and other metabolic changes, medication effects, intoxication or withdrawal, sleep-related events, paroxysmal movement disorders, and certain migraine phenomena can cause episodic collapse, shaking, altered awareness, or unusual sensory experiences. Panic attacks may produce palpitations, breathlessness, trembling, and fear, sometimes with dissociation. Detailed clinical chronology and selective examination are therefore essential.
A dissociative experience such as depersonalization or derealization may occur during a functional seizure without establishing a separate dissociative disorder. Conversely, people with dissociative disorders can have episodes that require independent neurological evaluation. For the clinical distinction between these diagnostic families, see how dissociative disorders are diagnosed.
The diagnosis should never be based on suggestions that an event seems theatrical, occurs in public, happens under stress, or changes when another person speaks. Such impressions do not establish intentional fabrication. Factitious disorder and malingering require their own high-stakes assessment of alleged intentional behavior and are not synonymous with functional seizures.
Why Do Functional Seizures Happen? What Research Supports
There is no single established cause that applies to every patient. Current models consider altered control of attention, awareness, perception, emotion and action; physiological arousal; learning and expectation; and interactions among individual vulnerabilities, bodily states, and social context. These are explanatory models supported to different degrees by clinical and experimental research. They should not be treated as a proven one-way mechanism in an individual patient. The ILAE 2025 report explicitly notes the absence of a specific biomarker of neuropathogenesis.
Symptoms sometimes begin after illness, pain, injury, surgery, severe stress, a frightening medical event, or an epileptic seizure. In other cases, no clear precipitating event is identified. The presence of a stressful life event establishes chronology and potential context, but individual causation requires a thoughtful formulation rather than a simple temporal assumption. Changes in attention to bodily sensations, anticipatory anxiety about events, avoidance and disruption to daily routines may contribute to persistence for some patients; these factors are clinical treatment targets rather than moral judgments.
Does Trauma Cause PNES?
Traumatic experiences and posttraumatic symptoms occur in a proportion of people with functional seizures, and some people benefit from trauma-focused assessment and treatment. Trauma is not required for diagnosis, and clinicians should not demand a trauma narrative or infer that forgotten abuse must have occurred. A 2026 systematic review of stressful life events in young people found heterogeneous study designs and limited control of confounding; its authors treated life stress as a possible contextual or vulnerability factor, not a defining or universally causal feature.
Can Functional Seizures Occur Without Anxiety or Depression?
Yes. Anxiety, depression, posttraumatic symptoms, and other psychological difficulties are clinically important to assess, but a co-occurring psychiatric diagnosis is not a requirement for identifying a functional seizure. Some patients have substantial psychological symptoms; others do not. The purpose of mental health assessment is to recognize treatable needs, understand the person's circumstances, and tailor care—not to retroactively prove the neurological diagnosis. See AAN practice recommendations.
Treatment: What Helps People With Functional Seizures?
Treatment is collaborative and typically involves a neurologist or epilepsy specialist and a mental health clinician who understands functional seizures. The goals commonly include fewer episodes, greater safety, less distress, improved participation in work and education, better sleep, and a sustainable quality of life. The 2026 AAN guideline finds that psychological interventions are possibly effective for seizure freedom, frequency, anxiety, quality of life, and psychosocial functioning, while acknowledging important limitations in the available trials.
The First Therapeutic Step: Understanding the Diagnosis
An effective explanation connects the person's actual event features to the clinical reasoning behind the diagnosis. Patients benefit from knowing which episodes were evaluated, how confident the team is, whether epilepsy remains possible, which medicines are indicated, and whom to contact if patterns change. Clinicians should offer a coherent, respectful explanation and maintain follow-up, rather than delivering the result as a dismissal. A trusted clinician can help translate assessment findings into a practical care plan that addresses physical and psychological consequences.
Psychotherapy and Seizure-Focused CBT
Seizure-focused cognitive behavioral therapy (CBT) and related structured psychological interventions aim to help people understand episode patterns, identify modifiable warning signs and responses, regulate arousal when useful, reduce disabling avoidance, improve coping, and return to valued activities. Treatment may include symptom monitoring, behavior change, attention and grounding strategies, emotional regulation, and work with relevant family or workplace patterns. The content is adjusted to the person rather than presuming a single cause.
The strongest large randomized study is the UK CODES trial. It randomized 368 adults to standardized medical care or seizure-specific CBT plus standardized care. At 12 months, the difference in the primary endpoint—monthly seizure frequency—was not statistically significant. Several secondary outcomes, including longer seizure-free intervals, psychosocial functioning, and perceived improvement, favored the CBT group. This nuanced result is important: psychotherapy has potential benefits, but the trial did not establish a statistically significant advantage on its primary frequency measure. See Goldstein and colleagues, 202030128-0) and the CODES trial report.
A smaller multicenter randomized pilot trial found improvements in seizure counts and aspects of functioning among participants receiving CBT-informed psychotherapy, alone or combined with sertraline, but it was too small to settle comparative efficacy. In that study, sertraline alone did not demonstrate a statistically significant seizure reduction. The findings support further use and research of specialized psychological treatment while underscoring the limits of small trial evidence. See LaFrance and colleagues, 2014.
The AAN synthesis draws on 12 Class II–III studies identified through February 2025 and concludes that psychological interventions are possibly effective, rather than guaranteeing remission. Treatment selection should account for readiness, accessibility, cultural fit, age, coexisting conditions, and individual preferences. When intervention is appropriate, clinicians should discuss its likely benefits and risks and include family or other supporters with the patient's agreement. See AAN, 2026.
Treating Comorbid Conditions
If depression, an anxiety disorder, PTSD, sleep disturbance, chronic pain, substance-related problems, or another medical condition is present, it merits assessment and evidence-based care in its own right. Medication may be prescribed for such conditions when indicated. A treatment for depression or anxiety should not be described as a drug proven to suppress functional seizures. The neurological and mental health teams should coordinate to avoid contradictory explanations, duplicate prescriptions, or fragmented follow-up.
Antiseizure Medications and Benzodiazepines
Antiseizure medicines treat epilepsy and certain other indicated conditions. They are not established treatments for functional seizures themselves. The 2026 AAN guideline recommends against prescribing antiseizure drugs or benzodiazepines for functional seizures when no co-occurring epilepsy or other indication exists; when such medicines are being taken without another indication, the guideline recommends clinician-supervised tapering. A patient must not independently stop, reduce, or switch prescribed antiseizure medication: unrecognized coexisting epilepsy, withdrawal risks, and other indications make individualized medical supervision essential.
Other Interventions and Experimental Approaches
Approaches such as general stress-management techniques, physiotherapy when a person has co-occurring motor FND, occupational rehabilitation, group education, or family work may be useful as components of coordinated care. Their precise contribution to functional seizure outcomes depends on the person and intervention. Device-based brain stimulation and other emerging interventions are under investigation, but clinical evidence is developing and should not be presented as equivalent to established, guideline-supported care. A 2026 systematic review of brain stimulation approaches reflects ongoing research rather than a universal treatment recommendation.
Seizure Safety: What To Do During an Episode
Until a reliable specialist diagnosis and individualized response plan are available, a seizure-like event should be approached with the same immediate attention to safety given to any unexplained seizure. Stay with the person, remove nearby hazards, cushion their head if they are on the ground, and keep track of the time. If it is safe and appropriate, turn the person gently on their side to help maintain an open airway. Do not restrain movements, put objects in the mouth, force food or drink, or give medication outside the prescribed emergency plan. The CDC seizure first-aid guidance provides public safety instructions.
Seek emergency assistance for a first seizure-like episode, an event lasting more than five minutes when the diagnosis and emergency plan do not clearly establish a different response, closely repeated events without recovery, breathing difficulty, significant injury, an event in water, or serious concerns such as pregnancy or diabetes with loss of consciousness. Use the local emergency number; in the United States call 911. Even in someone with a documented functional diagnosis, a materially new or dangerous presentation requires reassessment. The CDC lists situations that warrant emergency help.
When functional seizures are established, the treating team can develop a personalized plan detailing the usual event pattern, immediate safety steps, emergency thresholds, how to communicate with responders, and what to do about changes or suspected epileptic events. A written plan may reduce unnecessary repeated emergency treatment while preserving access to urgent care when needed. Emergency personnel should never assume that an unfamiliar episode is functional solely because that diagnosis appears in the record.
Driving, Swimming, Heights, and Work
Episodes involving loss of awareness, falls, sudden motor changes, or impaired control can affect driving and other safety-critical activities. Driving restrictions differ by jurisdiction and clinical circumstances; patients should discuss local licensing rules and individualized risks with their clinicians and relevant authorities before driving. Similar caution applies to swimming alone, bathing unsupervised when events are uncontrolled, climbing ladders, working near machinery, and other environments where sudden loss of control could cause injury. A safe activity plan should preserve independence where reasonable while addressing real hazards.
Living With Functional Seizures
Useful day-to-day work often begins with a consistent sleep schedule, sustainable physical activity, reliable meals and hydration, and a clear plan for seeking help. Some people benefit from tracking dates, circumstances, warning sensations, event patterns and recovery, but tracking should be brief enough that it does not intensify constant bodily monitoring. Activity can be rebuilt gradually with clinical support after prolonged avoidance or frequent events. Symptom-focused self-management supplements rather than replaces specialist assessment and treatment.
For school, university, and employment, consider practical accommodations such as safe rest space, a documented event response plan, flexible return after treatment appointments, or temporary changes in hazardous duties. Communication should respect confidentiality and avoid treating every episode as either an emergency or a behavioral problem. A clear written plan is especially helpful when different adults may witness the events. Families and care partners can support recovery by using a consistent agreed response, encouraging ordinary participation when safe, and avoiding blame.
People sometimes feel invalidated when a functional diagnosis replaces an earlier assumption of epilepsy. The transition can involve grief, uncertainty, and distrust, especially after a long diagnostic journey. It is appropriate to request clarification of the supporting evidence, the status of prior recordings, how coexisting epilepsy was considered, and what care will be available next. An appropriate second neurological opinion is reasonable when meaningful diagnostic questions remain.
Functional Seizures in Children and Adolescents
Children and adolescents can experience functional seizures. Evaluation must be developmentally appropriate and consider the child's account, caregiver observations, school setting, sleep, bullying or peer challenges when relevant, physical health, and potential seizure mimics. A diagnosis should be explained in language the child can understand without labeling the child as deliberately disruptive. The ILAE pediatric task force consensus supports comprehensive developmental assessment, event descriptions, vEEG where feasible, avoidance of deceptive provocation, and continued access to clinicians experienced with epilepsy.
Treatment planning can involve family-based support, age-appropriate psychological therapy, coordinated school participation, and specialist neurological follow-up. Young people should have a realistic return-to-school and social participation plan that balances safety and developmental needs. The evidence base for pediatric treatment remains smaller than the adult literature; retrospective designs predominate in the studies reviewed by the ILAE pediatric group. A 2026 youth systematic review found that stress exposures vary and should not be assumed to define every case.
Outlook: Can Functional Seizures Stop?
Recovery trajectories differ. Some patients improve after receiving a credible explanation, coordinated neurological follow-up, and appropriate treatment; others continue to experience frequent or disabling events. Improvements may involve fewer episodes, shorter recovery, greater confidence, better social or occupational functioning, and reduced emergency service use, even when seizures have not disappeared. Treatment studies measure different outcomes, so any claim about 'success rates' must specify what outcome, follow-up period, and population it describes.
The CODES trial illustrates why outcome measures matter: a nonsignificant difference in average seizure frequency at 12 months coexisted with improvements in several aspects of daily functioning and longer seizure-free periods. The AAN evidence synthesis supports a hopeful but realistic treatment plan, not a promised cure. Comorbid epilepsy, psychiatric conditions, injuries, social disadvantage, access to care, and quality of follow-up can influence clinical needs and should be addressed directly.
Functional seizures can carry serious health and psychosocial burdens. A 2026 large electronic health-records analysis found increased mortality compared with a reference population after adjustment for several measured confounders, although observational datasets cannot establish individual causation. Such findings reinforce the need to address medical comorbidity, injuries, access to care, and mental health rather than viewing the condition as trivial.
Mental Health, Self-Harm Risk, and Continuing Support
Some clinical groups with functional seizures have elevated rates of depression, distress, suicidal thoughts, or self-harm histories. This is a reason to assess mental health and safety sensitively, not to assume that any particular person is suicidal. A 2025 systematic-review conference abstract reported substantial pooled burdens but requires caution because results were presented in abstract form and included heterogeneous studies. Appropriate care includes direct assessment when concerns arise and timely support for anyone at risk. If someone is in immediate danger, contact local emergency services; for the United States, 988 provides crisis support. The AAN guideline recommends assessment for co-occurring psychiatric disorders.
Preparing for a Neurology or Epilepsy Clinic Visit
A useful appointment record describes each distinct kind of spell separately: when it began, typical duration, frequency, warning signs, movements, awareness and memory, injuries, and recovery. Bring a medication list, prior EEG and imaging reports if available, emergency-care records, and any safely obtained representative video. If possible, invite a witness who can accurately describe an event. The clinician may need to distinguish the person's most common event from rare but medically important alternative episodes.
Ask what positive clinical findings support the working diagnosis, which events have actually been captured, whether epilepsy or syncope still needs assessment, how confident the specialist is, what further tests would meaningfully change management, and which treatments are accessible. Request an emergency response plan, driving and activity guidance, medication instructions, and a named follow-up clinician. Involving trusted relatives or caregivers, with consent, can help the entire care network use the same evidence-based explanation.
Common Questions About Functional Seizures (PNES)
Can a Normal EEG Prove I Have PNES?
No. A normal routine EEG between events does not rule out epilepsy and does not establish functional seizures. Video EEG capturing a typical event may support a high-confidence diagnosis when interpreted by an appropriately trained specialist, but the clinical context and limitations of scalp recordings remain essential. See NICE and the ILAE staged approach.
Can I Have PNES and Epilepsy at the Same Time?
Yes. The two diagnoses can coexist, sometimes with different patterns of events. A neurologist needs to evaluate and document each type, and treatment decisions—including antiseizure medication—must account for any confirmed epilepsy. The AAN guideline specifically addresses co-occurring epilepsy.
Are Functional Seizures Just Panic Attacks?
No. The diagnoses describe different clinical phenomena, although autonomic arousal, fear, dissociation, and some outward signs can overlap. A seizure-like episode cannot be classified merely from the presence or absence of panic. Neurological and other medical causes require appropriate evaluation; see our panic attack versus seizure assessment guide.
Are Functional Seizures Caused by Childhood Trauma?
Some patients have trauma histories and some do not. Neither a trauma history nor the absence of one establishes the diagnosis or a universal cause. Current research studies multiple mechanisms and contextual influences. The 2026 youth review explains important limitations in trauma- and stress-related observational evidence.
What Is the Best Treatment for PNES?
A clear diagnosis, continuing neurological care, and a personalized treatment plan are the foundation. Specialized psychotherapy, including seizure-focused CBT, may improve a range of outcomes for some patients. The large CODES trial did not show a statistically significant difference on its primary seizure-frequency outcome, although several secondary outcomes improved. Consult the 2026 AAN guideline and CODES trial30128-0) for an evidence-based view.
Should I Stop My Epilepsy Medication After a PNES Diagnosis?
Do not stop it on your own. If there is no coexisting epilepsy or other indication, the AAN recommends clinician-supervised tapering of antiseizure medication used solely for functional seizures. If epilepsy is present or still being assessed, the medication decision may be different. Abrupt medication changes can be dangerous. Discuss an individualized plan with the prescribing clinician. See AAN, 2026.
Is PNES a Mental Illness or a Neurological Disorder?
Functional seizures are a clinical presentation at the intersection of neurology and mental health, and the official classification differs between DSM-5-TR and ICD-11. Neurologists assess the episodes and their neurological differential; mental health clinicians may provide evidence-informed psychological treatment or address co-occurring conditions. Classification should guide care while respecting the reality of symptoms.
Can Functional Seizures Happen During Sleep?
A reported episode occurring at night, during apparent sleep, or around awakening needs careful characterization. Some events that seem to begin from sleep actually arise after arousal, while nocturnal epileptic and sleep disorders are important alternatives. A sleep-related account alone cannot settle the diagnosis; the specialist may select appropriate EEG or sleep investigations.
When Should a Previously Diagnosed Patient Be Re-Evaluated?
Reevaluation is appropriate after a new or different event type, significant injury, unexplained prolonged unconsciousness, new focal neurological signs, changes in medication or medical illness that alter the risk assessment, or recurrent events despite a care plan. A historical functional diagnosis does not exclude later epilepsy or other medical conditions.
Related Articles
Panic Attack vs Seizure: Symptoms, Awareness, and Medical Assessment · How Dissociative Disorders Are Diagnosed: Interviews and Differential Diagnosis. Additional EN-14 topics, including the FND parent overview, functional seizures versus epilepsy and seizure-specific psychotherapy, will be linked here after their actual English publication.
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