Functional seizures are a real and involuntary medical condition, not a feigned or imagined one. Many people mistakenly believe these episodes are under conscious control, but this perception is inaccurate and harmful. While functional seizures may outwardly resemble other types of seizures, their underlying mechanisms are distinct. The experience of a functional seizure is a physical manifestation of complex internal processes, differing significantly from other seizure types at a neurological level.
Understanding Functional Seizures
Functional seizures, also known as Psychogenic Non-Epileptic Seizures (PNES), are episodes that look like epileptic seizures but are not caused by abnormal electrical activity in the brain. They are considered a type of functional neurological disorder (FND), where symptoms arise from temporary disruptions in how the brain functions, rather than structural damage. Individuals experiencing these seizures have no voluntary control over them.
The term “functional” signifies a problem with the brain’s “software” or “wiring” rather than its “hardware” or structure. During an episode, various physical manifestations can occur, similar to those seen in epileptic seizures. These may include full-body shaking, twitching or jerking of limbs, staring spells, unresponsiveness, or even sudden collapses. Some individuals might experience a brief lapse in awareness or rapid side-to-side head movements.
These episodes can be just as distressing and disabling as epileptic seizures. While the symptoms are physical and observable, their origin lies in complex mental and emotional processes. The episodes can vary in how often they happen, how long they last, and their severity.
Differentiating from Epileptic Seizures
Distinguishing functional seizures from epileptic seizures is crucial for accurate diagnosis and effective treatment. Epileptic seizures result from abnormal, uncontrolled electrical discharges in the brain. In contrast, functional seizures do not show this characteristic electrical activity on an electroencephalogram (EEG). This absence of epileptic brain activity is a primary diagnostic differentiator.
Medical professionals often use video-EEG monitoring to observe episodes and simultaneously record brain activity. During a functional seizure, the EEG will typically appear normal or show patterns inconsistent with epilepsy, even while the patient is experiencing convulsive movements. While both types of seizures can have triggers, the nature of these triggers often differs. Epileptic seizures might be provoked by factors like sleep deprivation or flashing lights, whereas functional seizures are frequently linked to emotional stress, trauma, or specific situations.
Differences can also be observed in episode duration and the post-seizure state. Functional seizures can sometimes last longer than five minutes, and the recovery period may not involve the profound confusion or deep sleep often seen after certain epileptic seizures. Some people with functional seizures may retain a degree of awareness during the event, even if they appear unresponsive, unlike the complete loss of consciousness that can occur in some epileptic seizures. The pattern of movements can also offer clues; for instance, asynchronous limb movements or eyes remaining closed during an apparent convulsion might suggest a functional seizure.
What Causes Functional Seizures?
Functional seizures are not caused by structural brain damage or a chemical imbalance in the same way epilepsy is. Instead, they are understood as a temporary disruption in the brain’s functional processes, often in response to psychological or emotional stressors.
Chronic psychological stress, anxiety, and depression are commonly associated with the development of functional seizures. Individuals may experience these episodes as an unconscious physical manifestation of underlying distress. A history of emotional, physical, or sexual trauma, particularly during childhood, is also a significant contributing factor for many individuals. Functional seizures can serve as an unconscious coping mechanism, a way for the brain to “cut off” or “dissociate” from painful memories or overwhelming emotions.
Co-occurring mental health conditions, such as anxiety disorders, post-traumatic stress disorder (PTSD), and dissociative disorders, are frequently observed in individuals with functional seizures. Not everyone with functional seizures will have a clear history of trauma or a diagnosed mental health condition, and some may not consciously recognize their stress before an episode. Onset can also occur years after a traumatic event or without an obvious preceding reason.
Diagnosis and Management
Diagnosing functional seizures typically involves a comprehensive evaluation by medical specialists, often including a neurologist. The gold standard for diagnosis is video-EEG monitoring, usually conducted in a specialized epilepsy monitoring unit. During this monitoring, episodes are recorded on video while the brain’s electrical activity is simultaneously measured. This allows doctors to confirm the absence of abnormal epileptic brain activity during the seizure-like events.
Once a diagnosis of functional seizures is confirmed, management strategies focus on addressing the underlying factors rather than using anti-seizure medications, which are ineffective for this condition. Psychotherapy is the recommended primary treatment modality. Cognitive Behavioral Therapy (CBT) is a widely used and effective form of psychotherapy for functional seizures, helping individuals understand how their thoughts and behaviors influence their physical symptoms. Trauma-focused therapies, such as prolonged exposure therapy, may be utilized if a history of trauma is identified.
Education and psychoeducation are important components of management, helping patients and their families understand the condition. Learning stress management techniques, such as relaxation and breathing exercises, can also be beneficial in reducing the frequency of episodes. While anti-seizure medications are not used to treat the seizures themselves, medications might be prescribed to manage co-occurring mental health conditions like depression or anxiety. Support groups can provide a valuable community for individuals navigating this condition, fostering understanding and shared coping strategies. Recovery is possible with appropriate diagnosis and a tailored treatment plan.