How to Stop Non-Epileptic Seizures

Stopping non-epileptic seizures, now increasingly called functional seizures, requires a fundamentally different approach from treating epilepsy. Anti-seizure medications do not work because these episodes are not driven by abnormal electrical discharges in the brain. Instead, the path forward typically combines an accurate diagnosis, a clear explanation of the condition, psychotherapy tailored to the individual’s triggers, and day-to-day self-management strategies like grounding techniques and breathwork. The process is rarely quick, but most people see meaningful improvement, and some become entirely seizure-free.

What Functional Seizures Actually Are

Functional seizures look and feel like epileptic seizures, but brain monitoring during an episode shows normal electrical activity. They are not faked or imagined. The episodes involve real, involuntary changes in movement, sensation, or awareness that the person cannot simply will away. The term “psychogenic non-epileptic seizures” (PNES) has been used for decades, but many clinicians and patients now prefer “functional seizures” because it better captures the idea of a brain-function problem without implying that the person is making it up or that the cause is purely psychological.¹

Neuroimaging research has started to reveal what is happening in the brain during these episodes. Studies consistently find abnormal connectivity between regions that process emotion and regions that control movement. Specifically, areas involved in emotional processing, such as the insula, show unusually strong connections to motor areas, while frontal regions responsible for inhibitory control do not keep those connections in check.² A separate systematic review confirmed that disrupted functional connections between emotion-processing areas and executive-control regions, particularly involving the anterior cingulate cortex, appear central to how these seizures arise.³ In practical terms, strong emotions or stress can bypass the brain’s usual filtering systems and produce a physical seizure-like response. Understanding this helps explain why psychological treatments work and why telling someone to “just stop” is about as useful as telling someone with a panic attack to calm down.

Getting the Right Diagnosis First

Nothing useful can happen until you know for certain whether your seizures are epileptic, functional, or both. The gold standard is video EEG monitoring, where you stay in a clinic wired to an EEG while cameras record your movements. If a typical episode occurs during monitoring and the EEG shows no epileptic discharges, the diagnosis is clear.⁴ ⁵

Clinicians also look at a constellation of features that differ between functional and epileptic seizures. Functional seizures tend to have a more gradual onset, often involve side-to-side head movements rather than stiffening, may last longer than a typical epileptic seizure, and the person may close their eyes during the episode (people having epileptic convulsions usually have open eyes). Occurring during apparent sleep that turns out not to be true sleep on EEG, sometimes called “pseudosleep,” is another distinguishing feature.⁶ None of these signs alone is definitive, which is why video EEG remains the standard. But recognizing these patterns can speed the diagnostic process and prevent years of being treated for the wrong condition.

The diagnostic delay is a real problem. Many people with functional seizures spend years on anti-epileptic medications that were never going to help. If you suspect your seizures are not epileptic, asking your neurologist about video EEG monitoring is a reasonable and important step.

Why the Way Your Doctor Explains the Diagnosis Matters

Getting the diagnosis is one thing. Understanding and accepting it is another, and this step turns out to be surprisingly powerful on its own. A study that evaluated a structured approach to communicating the diagnosis found that when patients received a clear, empathetic explanation along with a written leaflet, the vast majority found it understandable and felt their questions were addressed. Roughly 86% acknowledged that psychological factors were contributing to their seizures. Within three months, about 14% were completely seizure-free and over 60% reported that their seizure frequency had dropped by more than half.⁷

How the diagnosis is delivered also has financial consequences. When patients received what they considered a satisfactory explanation, their total healthcare costs fell by roughly a third in the year that followed. When the explanation was perceived as unsatisfactory, costs more than doubled, driven by continued emergency department visits and hospitalizations.⁸ A person who walks out of a diagnostic appointment confused, dismissed, or angry is far more likely to keep cycling through emergency rooms. A person who understands what is happening in their brain and feels believed has already started treatment, even before formal therapy begins.

The Role of Trauma and Psychological Triggers

Not everyone with functional seizures has a trauma history, but the association is strong. People with functional seizures consistently report higher rates of childhood adversity compared to people with epilepsy. One study found large differences in overall childhood trauma scores between the two groups, with emotional abuse and emotional neglect showing the biggest gaps. These findings held up when tested in a separate group of patients.⁹ Research from China replicated the pattern and also found that people with functional seizures reported more dissociative symptoms and more overall psychiatric distress.¹⁰

Beyond trauma itself, people with functional seizures are also more likely to have difficulty identifying and describing their emotions, a trait psychologists call alexithymia.¹¹ If you cannot recognize or put words to what you are feeling, those emotions are more likely to express themselves through the body. This is not a character flaw; it is a pattern that often develops in environments where expressing emotions was unsafe or discouraged. Understanding the link between unprocessed emotion and physical symptoms helps make sense of why therapy, and not medication, is the primary treatment.

Cognitive Behavioral Therapy

CBT is the most studied and most widely recommended treatment for functional seizures. It works by helping you recognize the thoughts, emotions, and bodily sensations that precede a seizure, then gradually changing how you respond to those triggers. Techniques typically include relaxation training, controlled exposure to stress triggers, and restructuring unhelpful thought patterns.¹²

A pilot randomized controlled trial found that seizure reduction after CBT was substantially better than standard medical care alone, with large effect sizes by the end of treatment. Patients who received CBT were about three times more likely to achieve a sustained period of seizure freedom.¹³ Case reports have also documented improvement in both seizure frequency and accompanying psychiatric symptoms like anxiety and depression.¹⁴

The largest trial to date, called CODES, tempered this optimism somewhat. It compared CBT plus standard medical care against standard care alone and found no statistically significant difference in the primary outcome of seizure frequency at 12 months. However, people in the CBT group had a significantly longer seizure-free period, better psychosocial functioning, greater self-rated and clinician-rated improvement, and higher treatment satisfaction.¹⁵ The takeaway is that CBT clearly improves quality of life and how well people function day to day, even if the headline seizure count does not always plummet. Seizure frequency is only one dimension of a condition that also involves anxiety, avoidance, social withdrawal, and lost work days.

Trauma-Focused Therapy and EMDR

When a clear trauma history underlies the seizures, trauma-specific approaches may help. Eye movement desensitization and reprocessing, or EMDR, has been explored in several case studies and small series. In one study of three patients with confirmed trauma-related functional seizures, EMDR eliminated seizures in two of them, and those patients remained seizure-free for 12 to 18 months.¹⁶ Another case report described complete recovery after 18 months of weekly EMDR sessions in a patient with post-traumatic stress disorder and functional seizures.¹⁷ In adolescents, two cases showed significant reductions in dissociative symptoms and no seizure recurrence at six-month follow-up after EMDR.¹⁸

These are small-scale studies, and there are no large randomized trials of EMDR specifically for functional seizures yet. But for someone whose seizures are clearly linked to traumatic memories, the results so far are encouraging enough that the approach is worth discussing with a therapist experienced in both trauma and functional neurological symptoms. EMDR and CBT are not mutually exclusive; some treatment plans combine elements of both.

Self-Management Strategies That Patients Report Actually Help

Between therapy sessions and beyond the clinic, you spend the vast majority of your time managing seizures on your own. A cross-sectional survey asked people with functional seizures what strategies they found most helpful. The top four were grounding and sensory techniques (reported helpful by about 46%), practical changes to home, school, or work life (41%), breathing exercises (31%), and movement or physical activity (27%).¹⁹

Grounding techniques are designed to interrupt the dissociative drift that often precedes a seizure. They work by anchoring your attention to the present moment through sensory input. Common examples include holding ice cubes, smelling a strong scent like peppermint oil, pressing your feet firmly into the floor, or naming five things you can see in the room. The idea is to interrupt the cascade before it becomes a full seizure. These techniques work best when practiced regularly during non-seizure times so that they become reflexive. Breathing exercises operate on a similar principle: slow, controlled exhalation activates the parasympathetic nervous system and can counter the physiological ramp-up that often precedes an episode.

Practical lifestyle adjustments matter too. Some people find that identifying and reducing specific stressors, getting consistent sleep, reducing caffeine, or adjusting their work schedule makes a significant difference in seizure frequency. These are not cures, but they reduce the overall burden on a nervous system that is already prone to misfiring under stress.

What to Do During an Episode

If you are with someone having a functional seizure, the first-aid principles overlap with epilepsy first aid in most respects: keep the person safe from injury, do not restrain them, do not put anything in their mouth, and gently position them on their side if possible. Record details about the episode, including how long it lasts and what it looks like, because that information is useful for clinicians later.²⁰

One difference from epileptic seizure first aid is that gentle verbal reassurance and grounding prompts can sometimes help during a functional seizure. Speaking calmly and saying things like “you’re safe” or “try to feel your feet on the ground” may shorten the episode for some people, though this varies widely. If the person has a seizure management plan developed with their clinical team, follow it. Calling an ambulance is appropriate if the episode lasts longer than usual, if the person is injured, or if you are uncertain whether the seizure is epileptic or functional.

Stopping Medications That Are Not Helping

Many people with functional seizures arrive at their diagnosis already taking one or more anti-epileptic drugs that were prescribed when their seizures were assumed to be epilepsy. These medications carry side effects, including drowsiness, weight gain, mood changes, and cognitive fog, without providing any benefit for functional seizures. Research has found that withdrawing anti-epileptic drugs in patients who do not have epilepsy is safe when done under appropriate supervision and with adequate follow-up.²¹ This should always be done gradually and through a clinic experienced in epilepsy diagnosis, not on your own. But getting off unnecessary medications is itself a meaningful step toward feeling better.

Physical Therapy and the Body-Based Angle

Functional seizures fall under the broader umbrella of functional neurological disorder, which can also involve movement problems, weakness, and gait abnormalities. Physical therapy from a practitioner familiar with functional neurological disorder has shown promise for these wider symptoms. One study found that attending more physical therapy sessions correlated with greater clinical improvement, and gait speed measurably improved after treatment.²² The treatment focuses on motor retraining, helping the brain relearn normal movement patterns.²³

Physical therapy is not a standalone treatment for seizures themselves, but it addresses the broader physical deconditioning and movement difficulties that often accompany them. Many people with functional seizures become afraid of physical activity because they worry it will trigger an episode. A skilled therapist can help rebuild confidence in the body’s ability to move safely, which feeds back into the overall recovery process.

Multidisciplinary Clinics and What Coordinated Care Looks Like

The most effective care models bring together neurologists, psychologists, psychiatrists, and physiotherapists who communicate with each other about your case. A feasibility study of a multidisciplinary group therapy clinic for functional seizures found that healthcare utilization dropped during and after the program.²⁴ Data from a dedicated functional seizures clinic showed that referral alone reduced emergency department visits and inpatient admissions, and cut average healthcare charges roughly in half.²⁵

These clinics are not available everywhere, which is a genuine barrier. If you do not have access to one, you can approximate the approach by ensuring your neurologist and therapist are communicating, ideally with the neurologist endorsing the psychological treatment plan. Having one provider who understands the condition send a clear letter to your primary care doctor and any emergency contacts can prevent unnecessary hospital admissions and redundant testing.

Children and Adolescents Have a Different Outlook

The prognosis for functional seizures in children is considerably better than in adults. A study following children for an average of about two and a half years after diagnosis found that 80% were completely seizure-free at follow-up, and another 12% had reduced frequency. Only 8% had persistent symptoms.²⁶ This held true despite a high rate of psychological difficulties in the group. The reasons are not entirely clear, but shorter duration of symptoms before diagnosis, greater brain plasticity, and the buffering effect of family involvement in treatment all likely contribute. For parents whose child has been diagnosed, the odds are genuinely encouraging.

Sleep Disruption as an Overlooked Factor

Poor sleep makes almost every neurological and psychiatric condition worse, and functional seizures are no exception. A polysomnography study comparing people with functional seizures to people with epilepsy found that over a quarter of those with functional seizures had both high rates of periodic limb movements during sleep and high arousal indices, suggesting probable sleep disruption that went unrecognized. High wake-after-sleep-onset times, a marker of fragmented sleep, were common in both groups and are known to increase dissociative tendencies.²⁷ If you have functional seizures and also sleep poorly, addressing the sleep problem, whether through behavioral strategies, treatment of a sleep disorder like restless legs, or simply enforcing consistent sleep timing, could reduce seizure vulnerability.

How Cultural Context Shapes the Condition

Functional seizures are not culture-bound, but the way they look can vary across populations. An international retrospective study found that the physical presentation of functional seizures differed across regions, with socioeconomic, cultural, ethnic, and religious factors potentially influencing what the seizures look like.²⁸ In some cultures, seizure-like episodes carry intense stigma, while in others they are interpreted through spiritual or religious frameworks. These differences matter for treatment because a person’s understanding of what is happening to their body shapes their willingness to engage in psychological therapy. Clinicians working across cultures need to take the time to understand the patient’s explanatory model and work within it, not against it. A therapist who dismisses a patient’s cultural framing is likely to lose that patient before treatment begins.