The term “PTSD seizure” is a common phrase used by the public to describe events medically known as Psychogenic Non-Epileptic Seizures (PNES). These events are not caused by abnormal electrical activity in the brain, which differentiates them from true epilepsy. Instead, PNES are physical symptoms of an underlying psychological condition, most often a Functional Neurological Disorder (FND) linked to trauma. Up to 90% of people diagnosed with PNES report a history of traumatic events, highlighting the strong connection between psychological stress and these physical manifestations.
Visual Characteristics of Functional Seizures
Functional seizures, or PNES, display physical characteristics that often distinguish them from epileptic events. The movements are typically asynchronous, meaning the body’s shaking and jerking are irregular and not rhythmic, unlike the synchronized stiffening and jerking seen in convulsive epileptic seizures. A common observation is fluctuating intensity, where the movements may wax and wane, stopping and starting unexpectedly. These events tend to be longer, frequently lasting for minutes or even over half an hour, which is significantly longer than most epileptic seizures.
Specific motor behaviors are frequently documented during a functional seizure. These include side-to-side head shaking (often in a “no-no” pattern), pronounced back arching (opisthotonus), pelvic thrusting, or rapid rolling. During the event, the person’s eyes may remain closed, sometimes with forceful resistance if an observer attempts to open them. Emotional vocalizations, such as crying or screaming, are also sometimes heard, reflecting the psychological distress at the root of the episode.
Distinguishing Features from Epilepsy
The most significant distinction between a functional seizure and an epileptic seizure lies in the brain’s electrical activity. During a PNES event, an electroencephalogram (EEG) shows no evidence of the excessive electrical discharge that defines an epileptic seizure. This absence of abnormal brain activity, confirmed by specialized Video-EEG monitoring, is the gold standard for diagnosis. Furthermore, PNES rarely involve the complete loss of bodily functions that often accompanies generalized tonic-clonic seizures.
While people with PNES sometimes report oral injury, lacerations to the side of the tongue are highly specific to convulsive epileptic seizures. Loss of bladder control (urinary incontinence) is also significantly less common in PNES compared to epileptic seizures. Following the event, individuals with a functional seizure usually recover full awareness almost immediately, quickly orienting themselves to their surroundings. This rapid reorientation contrasts with the post-ictal state of confusion, exhaustion, and drowsiness that typically follows a true epileptic seizure.
Underlying Connection to Trauma
Functional seizures represent a physical reaction to overwhelming psychological distress, often classified as a conversion disorder within the Functional Neurological Disorder spectrum. This involves the involuntary “conversion” of emotional pain and mental conflict into tangible physical symptoms, which the individual does not consciously control. The events are strongly associated with dissociation, a defense mechanism where the mind disconnects from the immediate surroundings or body during times of extreme stress or trauma. This mental disengagement can manifest physically as a seizure-like episode.
The brain appears to use this physical outlet as an involuntary way to process or escape psychological pressure. Trauma, particularly childhood trauma, is a common predisposing factor, suggesting the nervous system becomes wired to respond to stress with this physical breakdown. PNES episodes can be triggered by a specific stressful event, a reminder of past trauma, or a build-up of daily stress. Since the origin is psychological rather than structural damage to the brain, anti-epileptic medications are ineffective for PNES.
Immediate Response and Management
When witnessing a functional seizure, the immediate priority is to ensure the person’s physical safety. This involves gently guiding them away from sharp objects or hard surfaces and removing nearby furniture to prevent accidental injury during the movements. It is important to avoid restraining the person, as this can increase distress and resistance. Unlike epileptic seizures, there is no need to put anything in the person’s mouth, and attempts to suppress the movements are counterproductive.
The most appropriate response is to remain calm, speak in a reassuring voice, and protect the individual from harm until the episode passes. Long-term management of PNES focuses on addressing the underlying psychological causes, not on pharmacological treatments designed for epilepsy. The gold standard for treatment is psychotherapy, particularly trauma-focused approaches like Cognitive Behavioral Therapy (CBT). This therapy helps the individual understand the connection between their emotional state and physical symptoms, aiming to teach new coping mechanisms and reduce the frequency of functional seizures.