When people search for “fake seizures,” they are often seeking information about a real, involuntary medical condition that mimics epilepsy. These episodes are not caused by the abnormal electrical activity in the brain that defines true epileptic seizures. The term “fake” carries an undeserved negative connotation for those who experience them. These episodes are genuine physical manifestations arising from a source other than a neurological disorder.
The Correct Terminology
The medical community uses the term Psychogenic Non-Epileptic Seizures (PNES) to accurately describe these events. The word “psychogenic” indicates that the seizures originate from psychological or emotional distress, not from a physical brain abnormality like epilepsy. The episodes fall under the broader category of Non-Epileptic Seizures (NES).
The older, less accurate term, “pseudoseizures,” is now largely avoided by healthcare professionals because it wrongly implies that the person is consciously pretending. PNES are involuntary, and the individual has no conscious control over their onset or duration. The episodes represent a physical reaction to significant internal stress or emotional conflict.
How They Differ from Epilepsy
PNES episodes can closely resemble epileptic seizures, making accurate diagnosis a challenge for observers and medical staff. However, there are typically observable differences in the physical movements and the person’s state during and immediately after the event. Unlike the synchronized, rhythmic jerking seen in generalized epileptic seizures, PNES frequently involve asynchronous movements, such as side-to-side head shaking or thrashing of all four limbs.
The movements during PNES may also wax and wane in intensity or feature unusual behaviors like pelvic thrusting or crying, which are not typical of epilepsy. PNES episodes often last much longer than epileptic seizures, sometimes continuing for many minutes or even hours. A person experiencing PNES may also resist efforts to open their eyes, while the eyelids of a person having an epileptic seizure are often open.
After an epileptic seizure, the patient commonly experiences a period of confusion, drowsiness, and slow recovery known as the post-ictal state. Conversely, individuals with PNES often have a relatively quick and clear recovery, regaining full alertness within seconds or minutes of the episode ending. The definitive difference lies in the brain’s electrical activity.
Underlying Causes and Triggers
PNES are understood to be a manifestation of psychological distress, where severe emotional conflict or stress is converted into physical symptoms. This condition is often classified as a type of Functional Neurological Disorder (FND) or conversion disorder. The episodes are thought to occur when the brain’s functional networks related to emotional regulation and stress response become disrupted.
There is a strong connection between PNES and underlying mental health conditions, including anxiety disorders, depression, and particularly Post-Traumatic Stress Disorder (PTSD). Many people diagnosed with PNES report a history of psychological, emotional, or physical trauma, often dating back to childhood. The brain uses the physical event as an unconscious defense mechanism to release or avoid overwhelming emotional pain.
The events can be triggered by life stressors, such as major loss, family conflict, or an acute stressful situation. However, the underlying vulnerability is often a long-standing difficulty in processing or expressing intense emotions.
Diagnosis and Management
The definitive diagnosis of PNES requires ruling out epilepsy. The gold standard diagnostic tool is Video-Electroencephalography (Video-EEG) monitoring, which simultaneously records the patient’s physical behavior and the electrical activity of their brain. During a PNES event captured on Video-EEG, the recordings show a lack of the abnormal electrical discharges that would be present in an epileptic seizure.
Once PNES is confirmed, the management approach shifts entirely away from standard anti-seizure medications, which are ineffective. The primary focus of treatment is addressing the underlying psychological causes of the episodes. This typically involves psychological therapies aimed at helping the person process trauma and develop healthier coping mechanisms for stress.
Cognitive Behavioral Therapy (CBT), especially trauma-focused variants, has shown to be an effective treatment for reducing the frequency of PNES episodes. Treatment involves a collaborative effort between neurologists and mental health professionals, such as psychiatrists or psychologists. A clear explanation of the diagnosis to the patient and their family is an important first step toward recovery.