Non-epileptic seizures: real events, no epilepsy, and a brain that can relearn.

The EEG was normal during an episode and someone said the word psychogenic. You were not faking. Here is what the diagnosis actually means.

This page is about understanding the condition and the role the brain and nervous system can play in it. It is not a diagnosis. Your own clinicians know your case.

What psychogenic non-epileptic seizures are

A psychogenic non-epileptic seizure is an episode that resembles an epileptic seizure: shaking or thrashing of the limbs, falling, stiffening, unresponsiveness, sometimes with eyes closed, lasting from under a minute to many minutes. The difference is what the brain's electrical activity is doing. In epilepsy, an EEG recorded during a seizure shows the characteristic electrical storm. In PNES, the EEG during an episode is normal. Video-EEG monitoring, which records both the event and the brain's activity at the same time, is the gold standard for telling them apart.

The condition goes by several names. Functional seizures and dissociative seizures are now preferred by many clinicians and patients, because 'psychogenic' is often heard as 'fake'. They are not fake. They are involuntary, frightening and disabling, and they sit within the family of functional neurological disorders, alongside functional weakness, tremor and gait problems.

Getting the diagnosis right matters enormously. Many people are treated for years with anti-seizure medication that cannot work because there is no epilepsy, while the treatment that can work is never offered. Some people have both epilepsy and PNES, which is why specialist evaluation is essential.

The neuroplastic contribution

The ATNS Index of Neuroplastic Symptoms does not hedge here. It describes psychogenic non-epileptic seizures as a form of neuroplastic symptoms, and notes that research has shown a strong association with childhood sexual abuse.

Neuroplastic symptoms are real, physical symptoms produced by learned pathways in the brain and nervous system rather than by ongoing damage or disease. In PNES, the brain has learned a response to overwhelming internal states, often fear, memory, or unbearable emotion, that involves disconnecting from awareness and discharging through the body. For someone whose early life included trauma that could not be escaped or spoken about, that pattern can begin as a survival strategy. Later, it fires in response to stress, bodily sensations, reminders of the past, or even the fear of having another episode, whether or not the person is aware of a trigger. The episodes are not chosen. They run below the level of conscious control, like a reflex.

Two things follow from this. First, the diagnosis is not an accusation. Second, it is a route to treatment that epilepsy drugs cannot offer, because what has been learned can be relearned. Not everyone with PNES has a trauma history; the association is strong but not universal, and the model holds either way.

• Episodes that follow stress, conflict, or bodily sensations that resemble panic.
• Gradual onset, long duration, fluctuating intensity, eyes closed, or tearfulness afterward.
• Episodes that never occur during sleep recorded on EEG.
• No response to anti-seizure medication.

What the research shows

On the association the index describes: a 1993 controlled study found that a history of sexual or physical abuse was reported by about 32 percent of people with non-epileptic seizures compared with about 9 percent of people with epilepsy, and that abuse was more severe in the non-epileptic group. A 2022 study comparing childhood trauma in people with epileptic versus non-epileptic seizures found higher trauma across all types in the non-epileptic group, with no single trauma type standing out, and reported that asking about sexual abuse history shows the most promise as a screening question. A 2025 study from China found lower reported rates in Asian cohorts and summarized a systematic review in which around a third of PNES patients reported childhood sexual abuse. Rates vary with culture and willingness to disclose, so these are associations, not a test.

On treatment: an early prospective study of cognitive behavioural therapy for PNES in outpatients with video-EEG-confirmed diagnosis found that of 17 people who completed the program, 11 reported no seizures by the final session. A scoping review of randomized trials of psychotherapeutic treatment for psychogenic seizures summarizes subsequent trials, including a pilot randomized trial of CBT against standard care in 66 patients and a pediatric trial of an adapted retraining and control therapy, reporting reductions in seizure frequency and improvements in functioning. The trials are mostly small and preliminary, but they point consistently in one direction: a learned brain response can be changed with the right kind of work. Read more about the approach in FND and ACT.

Signs the brain may be part of the picture

• Video-EEG monitoring has captured an episode with normal brain electrical activity.
• Anti-seizure medication has not reduced the episodes.
• Episodes are triggered by stress, emotion, reminders, or body sensations, or happen in the presence of others.
• You have a history of trauma, abuse, or a period of life you have never been able to talk about.
• You also have other functional or sensitized-system symptoms: chronic pain, fatigue, dizziness, irritable bowel, dissociation.
• You feel a warning sensation, such as heat, tingling or a sense of unreality, before some episodes.

A solution that addresses it

There is an approach that addresses the learned brain response: symptom reprocessing. It starts with education, so the diagnosis makes sense as a real, involuntary brain pattern rather than a dismissal. It uses somatic tracking to notice warning sensations early and with curiosity, grounding and threat-reduction practices to interrupt the slide into an episode, a graded return to the activities and independence that fear has taken away, emotional awareness and expression for feelings that have had no other outlet, and acceptance and commitment skills. For PNES this work belongs with trained clinicians, including neurologists, psychologists and trauma-informed therapists, with digital programs increasingly supporting the daily practice between sessions.

Cindra is a daily AI companion built around these approaches, with daily check-ins, short practices and plain-language lessons for people whose symptoms have a neuroplastic component. If you have this diagnosis and want to practise the skills every day, you can join the waitlist.

What to do next

Get a definitive diagnosis. Ask for referral to an epilepsy centre for video-EEG monitoring if that has not been done; the diagnosis should rest on a recorded episode, not on a hunch. Do not stop anti-seizure medication on your own, even if you suspect PNES, since some people have both conditions and withdrawal must be managed by a neurologist. Seek emergency care for any episode lasting more than five minutes, injury during an episode, or a seizure that is different from your usual pattern.

Once PNES is confirmed, ask directly for referral to psychological treatment designed for functional seizures, and ask whether your pattern fits neuroplastic symptoms. If trauma is part of your history, say so to a clinician you trust; it changes the approach for the better. Then begin learning and practising daily. Grounding and somatic practices give you something to do in the moments before an episode, which is where control begins to return.

This article is for general education and is not medical advice, and it does not diagnose or treat any condition. Persistent symptoms deserve a proper medical assessment to rule out disease or injury before a neuroplastic explanation is considered. If your symptoms are new, changing, or come with red-flag signs such as fever, unexplained weight loss, numbness or weakness, chest pain, or loss of bladder or bowel control, see a clinician promptly.