A pseudoseizure is an episode that looks like an epileptic seizure but isn’t caused by abnormal electrical activity in the brain. The person may shake, lose awareness, or fall to the ground, yet their brain waves remain normal throughout the event. The medical community has moved away from the term “pseudoseizure” because it implies the person is faking. The preferred term today is psychogenic nonepileptic seizure, or PNES.
Why the Term “Pseudoseizure” Is Outdated
The prefix “pseudo” means false, which leads many people, including some healthcare providers, to assume these episodes are deliberately faked. They are not. PNES episodes are involuntary behavioral responses to psychological triggers or stress. The person experiencing them has no conscious control over what is happening, and the distress is very real.
Medical classifications now place PNES alongside other conditions where psychological distress manifests as physical symptoms. The DSM-5 classifies PNES as a form of conversion disorder, while the International Classification of Diseases (ICD-11) categorizes it as a dissociative disorder. Both frameworks recognize these episodes as genuine medical events with psychological roots rather than neurological ones.
How PNES Differs From Epileptic Seizures
Epileptic seizures are caused by a sudden surge of synchronized electrical activity in the brain. PNES episodes produce no such electrical changes. During monitoring, a person with PNES will show completely normal brain wave patterns before, during, and after an event.
Several features can help distinguish the two, though no single sign is definitive on its own. PNES episodes tend to last longer than epileptic seizures, which typically resolve within one to two minutes. People with PNES are more likely to report intense fear or negative emotions building before an episode, along with anxiety symptoms like rapid breathing. During the event, they more often experience dissociative feelings such as depersonalization and a distorted sense of time. Afterward, crying and continued fear are more common in PNES, whereas people recovering from epileptic seizures are more often confused or drowsy.
How Common PNES Is
PNES is far more common than most people realize. Between 20% and 40% of patients hospitalized in epilepsy monitoring centers for uncontrollable or atypical seizures turn out to have PNES rather than epilepsy. Many of these patients have been living with the wrong diagnosis for years.
That misdiagnosis carries real consequences. One study found that 60% of patients with PNES were taking anti-epileptic medications at the time they were correctly diagnosed. These drugs do nothing for PNES because there is no abnormal brain activity to suppress. Meanwhile, they expose people to unnecessary side effects ranging from drowsiness and weight changes to more serious risks.
What Causes PNES
PNES is the body’s response to psychological distress that the mind struggles to process directly. The most common underlying factors include past trauma, chronic stress, anxiety disorders, and unresolved emotional conflict. In many cases, the person may not even be consciously aware of the connection between their psychological state and their physical symptoms.
Think of it this way: when the brain cannot express or cope with overwhelming stress through normal emotional channels, it can convert that distress into physical symptoms. The seizure-like episodes are essentially the nervous system’s alarm response misfiring in a dramatic, visible way.
How PNES Is Diagnosed
The gold standard for diagnosing PNES is video-EEG monitoring. This test simultaneously records brain electrical activity through electrodes on the scalp while a video camera captures the person’s physical behavior. When an episode occurs during monitoring, doctors can compare what the body is doing with what the brain is doing.
In a typical PNES event, the EEG background remains completely normal in the waking state before, during, and after the episode. This combined analysis of physical behavior alongside brain wave data allows a definitive diagnosis in nearly all cases. Sometimes excessive movement during a convulsive episode can create so much electrical noise that the EEG is hard to read, but a completely normal brain wave pattern immediately before and after the event is still highly suggestive of PNES.
One complication: about 30% of certain focal epileptic seizures also produce minimal EEG changes, which is why the video component and expert interpretation are so important. This is not a test you can interpret from a printout alone.
Treatment and Recovery
Because PNES has psychological rather than neurological roots, the primary treatment is psychotherapy, particularly cognitive behavioral therapy (CBT). The therapy typically focuses on identifying the emotional triggers behind episodes, recognizing how thoughts and feelings influence the body’s stress response, and building coping strategies for managing distress before it escalates into a physical event.
The results are encouraging. A meta-analysis of 13 studies involving 228 people with PNES found that 47% stopped having seizures entirely after completing therapy. In one study, patients went from a median of eight episodes per week to zero by the end of CBT treatment. Another trial found that monthly seizure frequency dropped from 12 at the start of treatment to two at the end, and continued improving to 1.5 per month at the six-month follow-up. In patients treated with up to 14 CBT sessions, 79% achieved full or partial remission of seizures, and emergency department visits dropped sevenfold.
CBT for PNES often involves weekly sessions over roughly 10 to 14 weeks. Treatment may include journaling, monitoring thought patterns, processing past trauma, and practicing techniques to interrupt the cycle of stress that leads to episodes. For people with a history of trauma, therapy also addresses flashbacks, nightmares, and the tendency to suppress difficult emotions.
Combining therapy with certain medications may offer additional benefit. One trial found that CBT combined with an antidepressant reduced seizure frequency by about 59%, compared to 51% with therapy alone and 27% with medication alone.
Long-Term Outlook
Getting the correct diagnosis is itself a turning point. Many people feel relief simply knowing their episodes have a name and an explanation, and that they are not “crazy” or faking. But PNES is not something that resolves overnight. A long-term follow-up study with a median tracking period of four years found that seizure frequency decreased significantly over time, with about 32% of patients becoming completely seizure-free. That means the majority still experience some episodes, though often far less frequently than before diagnosis and treatment.
The people who do best tend to be those who engage consistently with therapy and who have a strong understanding of their own emotional triggers. Recovery is not just about stopping the episodes. It is about addressing the underlying psychological distress that drives them, which often improves overall quality of life well beyond the seizures themselves.