Non-epileptic seizures (NES) are episodes that look identical to epileptic seizures but are not caused by abnormal electrical activity in the brain. The most common form is Psychogenic Non-Epileptic Seizures (PNES), a functional neurological disorder with a psychological origin. These events are genuine and involuntary; the person experiencing them has no conscious control over their onset or duration. Stopping these episodes requires addressing the underlying psychological distress and developing new ways to cope with emotional overwhelm, rather than using traditional anti-seizure medications. Cessation centers on specialized psychotherapy that helps the brain find healthier outlets for emotional tension.
Understanding the Psychological Basis of These Events
PNES episodes are a physical manifestation of psychological distress, where the brain converts extreme emotional stress into physical symptoms. This response often links to underlying conditions such as trauma, anxiety, or mood disorders. The episodes frequently function as a defense mechanism, particularly for individuals who struggle with identifying or expressing intense feelings.
The central mechanism is dissociation, a process where the mind detaches from the current moment, feelings, or the body. When emotional processing capacity is overwhelmed, the nervous system triggers this dissociative state as a survival mechanism. The seizure-like event is a physical ‘shut down’ or an unconscious expression of unprocessed emotional content. This explains why the episodes lack the abnormal electrical discharges seen on an electroencephalogram (EEG) during true epilepsy. The episodes are an automatic, learned response to overwhelming internal or external stress.
Foundational Treatment: Psychotherapy for Cessation
Psychotherapy is the primary and most effective treatment for achieving the cessation of PNES. The goal is to help the person understand the psychological origin of the events and acquire skills to manage emotional triggers before they lead to a physical shutdown. Specific protocols, such as Cognitive Behavioral Therapy (CBT) tailored for PNES (CBT-PNES), have shown significant efficacy.
Cognitive Behavioral Therapy (CBT)
CBT for PNES typically involves psychoeducation, helping the person identify the unique thoughts, feelings, and situations that precede an episode, often called the “aura” or warning signs. The therapy focuses on challenging maladaptive thought patterns and developing active coping strategies to interrupt the cycle between a trigger and the seizure event. Studies demonstrate that patients receiving specialized CBT can experience a reduction in seizure frequency, with some research indicating that nearly half of patients become seizure-free.
Trauma-Focused Therapies
When trauma is identified as a contributing factor, trauma-focused therapies may be integrated into the treatment plan. These can include Eye Movement Desensitization and Reprocessing (EMDR) or Cognitive Processing Therapy (CPT). These therapies help the person process and integrate traumatic memories in a safe environment, which reduces the emotional charge of the trauma and diminishes the need for the dissociative physical response.
Anti-epileptic drugs (AEDs) are ineffective for PNES and should generally be discontinued if they are being used solely to treat these events. Continuing AEDs can reinforce the misperception of having epilepsy and expose the person to unnecessary side effects. Medication, if used, is reserved for treating co-occurring psychiatric conditions like severe depression or anxiety.
Immediate Management and De-escalation During an Event
The immediate goal during an active PNES event is to ensure the person’s physical safety while using de-escalation techniques. Unlike first aid for epileptic seizures, do not attempt to put anything in the person’s mouth or physically restrain them, as this can worsen the event. The initial step is to gently guide the person away from any potential hazards, such as sharp objects or hard surfaces, and place soft materials under their head.
A calm, reassuring presence is important, and you should speak to the person in a quiet, firm voice. Gentle de-escalation techniques aim to help the individual “ground” themselves and reconnect with their surroundings. This can involve simple, direct commands focused on the five senses, such as asking them to look at a specific object, feel the texture of their clothing, or state the current date.
If the person is partially responsive, encourage deep, rhythmic breathing to engage the parasympathetic nervous system. The focus should be on helping them regain a sense of control and reality without being intrusive or accusatory. Recognizing the event as PNES, rather than a medical emergency, helps avoid reinforcing the physical manifestation of distress.
Long-Term Strategies for Preventing Recurrence
Sustaining cessation after formal therapy involves integrating proactive, daily living strategies focused on emotional regulation and stress management. A core long-term strategy is consistent trigger identification, which involves maintaining a diary to track stressors, environments, or emotional states that precede an event. This allows for the preemptive use of coping skills learned in therapy, such as deep breathing or self-soothing techniques, before an episode gains momentum.
Structured stress reduction techniques should be incorporated into the daily routine, including mindfulness practices and relaxation exercises. These practices enhance a person’s ability to tolerate and respond to emotional distress without resorting to dissociation. Maintaining consistent sleep hygiene is also important, as sleep deprivation is a common trigger that lowers the threshold for emotional tolerance.
A well-informed support system is valuable for preventing recurrence and managing potential relapse. Family and close friends should be educated about the nature of PNES, the de-escalation techniques, and the importance of supporting the person’s emotional work. The long-term effort shifts from eliminating the seizure to fostering a durable sense of self-efficacy and emotional resilience.