What are Psychogenic Non-Epileptic Seizures?
**Psychogenic Non-Epileptic Seizures (PNES), also known as functional seizures or dissociative seizures, are episodes that look like epileptic seizures but are not caused by abnormal electrical activity in the brain. Instead, PNES is a psychological condition that is frequently associated with underlying emotional or mental health problems such as trauma, stress, or anxiety. These episodes may include convulsions, loss of consciousness, or other seizure-like symptoms, making them easily confused with epileptic seizures.
PNES belongs to the broader category of conversion disorders, in which psychological distress manifests as physical symptoms. PNES, in contrast to epileptic seizures, which are caused by neurological dysfunction, has an emotional or psychological component. PNES is typically diagnosed using video-EEG monitoring, which captures seizure activity while monitoring brain waves, demonstrating that the episodes do not contain the electrical disruptions seen in epilepsy.
This condition can be difficult to diagnose and treat. Many people with PNES are initially diagnosed with epilepsy, and treatment plans may include ineffective anti-seizure medications. Early detection of PNES is critical for avoiding unnecessary treatments and providing patients with appropriate interventions, which frequently include psychological therapy. While PNES has a significant impact on quality of life, it is treatable, particularly with a multidisciplinary approach.
Traditional Treatment Options for Psychogenic Non-Epileptic Seizures
Treating Psychogenic Non-Epileptic Seizures (PNES) necessitates a comprehensive and multidisciplinary approach that addresses both the physical symptoms of seizures and the underlying psychological causes. Because PNES is unrelated to epilepsy, conventional anti-seizure medications are ineffective. Instead, treatment emphasizes psychotherapeutic interventions, mental health support, and strategies for improving emotional regulation and stress management.
1. Cognitive Behavioral Therapy (CBT): Reframing Emotions
One of the most effective traditional treatments for PNES is Cognitive Behavioral Therapy (CBT), a psychological approach that assists patients in identifying and changing unhelpful thought patterns and behaviors. CBT aims to target the emotional and cognitive triggers that cause non-epileptic seizures.
CBT sessions frequently focus on assisting patients in understanding the relationship between their thoughts, emotions, and physical symptoms. For example, patients may be taught to recognize how stress or anxiety can cause a seizure and work on developing healthier coping mechanisms. CBT also helps patients develop resilience, manage anxiety, and reduce emotional reactivity to stressors, all of which can reduce the frequency and severity of PNES episodes.
In clinical practice, CBT has shown significant success in managing PNES. Patients frequently report fewer seizures, better emotional control, and a higher overall quality of life. While CBT is a gradual process that may take weeks or months of therapy, its structured approach provides long-term benefits for people with PNES.
2. Psychoeducation: Empowering Patients With Knowledge
Psychoeducation is critical in the management of PNES. Because many people with PNES are initially diagnosed with epilepsy or are unaware of the psychological causes of their condition, understanding the true nature of PNES is frequently the first step toward effective treatment.
During psychoeducation, healthcare providers explain how emotional stressors and psychological factors influence PNES. This process helps to demystify the condition, reduce fear, and promote a better understanding of how mental health affects physical symptoms. It can also help to reduce stigma for both the patient and their family by educating them that PNES is a legitimate medical condition caused by psychological mechanisms rather than neurological dysfunction.
Psychoeducation frequently includes teaching patients to recognize potential triggers and early warning signs of impending seizures. Learning these patterns allows patients to intervene before a full episode occurs, giving them the ability to use coping strategies to prevent or mitigate seizures.
3. Trauma-Focused Therapy: Treating Underlying Psychological Distress
Because many people with PNES have experienced significant trauma or emotional stress in their lives, trauma-focused therapies are an important part of treatment. These therapies aim to address the underlying psychological conflicts that frequently cause seizures.
- Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a structured therapy that helps people process traumatic memories that may be causing them distress. EMDR reduces the emotional intensity of traumatic memories and assists patients in working through unresolved emotional conflicts. This technique has proven especially beneficial for PNES patients with a history of trauma, allowing them to regain control of their emotional responses and reduce seizure episodes.
- Trauma-Informed CBT: For patients with trauma-related PNES, trauma-informed CBT combines cognitive behavioral therapy principles with a focus on resolving past trauma. By addressing the emotional wounds caused by traumatic events, this approach assists patients in developing healthier coping mechanisms, reducing the frequency of seizures.
4. Stress Management Techniques: Developing Emotional Resilience
Stress is a major trigger for PNES, and learning to manage stress is critical to reducing seizure frequency. Traditional treatments frequently incorporate a variety of stress management techniques to assist patients in regulating their emotional responses to daily challenges.
- Relaxation Training: Techniques like deep breathing exercises, progressive muscle relaxation, and guided imagery aid patients in managing stress in the moment. These methods are especially useful when patients detect early signs of emotional overload, which could lead to a seizure.
- Mindfulness-Based Stress Reduction (MBSR): MBSR teaches people to stay in the present moment and detach from distressing thoughts, which helps them manage anxiety and reduce emotional reactivity. Mindfulness practices are especially effective at promoting emotional balance and preventing stress from resulting in a seizure.
5. Family Therapy and Support: Building the Support Network
Family dynamics frequently play a role in PNES, and involving the patient’s family in treatment can help improve outcomes. Family therapy aims to address any dysfunctional communication patterns or emotional stressors within the family that may be contributing to the patient’s condition. Family members can also benefit from learning more about PNES, which helps to reduce misunderstandings and stigma.
Patients with a strong support network typically have better outcomes, and family involvement can help patients feel emotionally supported as they progress through their treatment. Family therapy can also provide loved ones with strategies for helping patients manage stress and prevent seizures in the home environment.
6. Medication for Coexisting Mental Health Conditions
Although anti-seizure medications are ineffective for treating PNES, they can help with coexisting mental health conditions like anxiety, depression, or post-traumatic stress disorder (PTSD).
- Antidepressants, specifically Selective Serotonin Reuptake Inhibitors (SSRIs), may be prescribed to treat underlying mood disorders. Medications like sertraline or citalopram help to stabilize mood, reduce anxiety, and improve emotional regulation, which can reduce the frequency of seizures.
- Anxiolytics: In some cases, patients with severe anxiety who develop PNES may benefit from short-term use of anxiolytics such as buspirone. However, because of the risk of dependence, these medications are generally used with caution.
The Most Recent Treatment Options for Psychogenic Non-Epileptic Seizures.
With increased research into Psychogenic Non-Epileptic Seizures (PNES), new treatment approaches are being developed that provide more targeted and effective relief. These innovations bring together the most recent findings in neuropsychology and integrative therapies to address the complex nature of PNES on both the psychological and neurobiological levels.
1. Neurofeedback: rewiring the brain’s emotional responses
Neurofeedback is a promising new approach to treating PNES. This therapy helps patients gain control of their emotional and cognitive responses by monitoring brain activity in real time.
In a neurofeedback session, electrodes are placed on the patient’s scalp to monitor brainwave activity. Patients are then given feedback—usually in the form of visual or auditory signals—on their brain’s electrical patterns. Patients gradually learn to consciously alter these brainwave patterns, which promotes better emotional regulation and reduces the frequency of seizures.
Neurofeedback has been shown in studies to help retrain the brain’s stress response, making it an effective treatment for PNES. Neurofeedback, which directly targets the brain’s emotional centers, provides a unique solution for patients who struggle with traditional psychotherapy alone.
2. Virtual Reality Exposure Therapy (VRET): An Innovative Trauma Treatment
Virtual Reality Exposure Therapy (VRET) is a novel treatment that enables people to confront and process traumatic memories in a safe virtual environment. For patients with PNES who have experienced trauma, VRET provides a safe and immersive way to address unresolved emotional issues that may cause seizures.
Patients are guided through triggering situations or memories via a virtual reality headset. This immersive therapy enables them to confront their experiences while also practicing relaxation and emotional regulation techniques. VRET has been shown in studies to be particularly effective for trauma-related conditions, providing hope for PNES patients whose seizures are associated with past trauma.
3. Acceptance and Commitment Therapy (ACT): Increasing Psychological Flexibility
Acceptance and Commitment Therapy (ACT) is another novel approach that is gaining popularity for treating PNES. ACT aims to help patients accept their emotional experiences rather than control or eliminate them. The goal is to increase psychological flexibility, allowing patients to express their emotions without feeling overwhelmed.
ACT encourages patients to accept that emotional distress is a normal part of life and teaches them to distance themselves from negative thoughts or feelings that may trigger seizures. Accepting their emotions and focusing on meaningful life goals can help patients reduce the emotional distress that causes PNES episodes.
4. Hypnotherapy for Unlocking the Subconscious Mind
Hypnotherapy is being investigated as a potentially effective treatment for Psychogenic Non-Epileptic Seizures (PNES) by assisting patients in accessing and processing subconscious thoughts and emotions that may be causing their seizures. Hypnotherapy entails putting the patient in a state of deep relaxation and focused attention, allowing the therapist to work with their subconscious mind to uncover underlying psychological conflicts or traumatic memories.
Hypnotherapy can help individuals with PNES identify emotional triggers that traditional therapy may not immediately reveal. Once these triggers are identified, the therapist can help the patient reframe their emotional responses and develop healthier coping strategies. Hypnotherapy has been shown to reduce the frequency of PNES episodes in some patients by addressing underlying psychological factors.
While hypnotherapy is not for everyone, it is gaining popularity as a complementary treatment, particularly for patients who have not responded to traditional therapies. Hypnotherapy, when combined with other therapeutic interventions such as cognitive behavioral therapy or trauma-focused therapy, has been shown in studies to improve seizure control significantly.
5. Transcranial Magnetic Stimulation (TMS): Modifying Brain Activity
Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure in which magnetic fields stimulate specific areas of the brain. TMS, which was originally developed to treat depression and other mood disorders, is now being investigated for its potential use in managing PNES.
TMS works by focusing on areas of the brain involved in emotional regulation, such as the prefrontal cortex, which may be dysregulated in PNES. TMS aims to improve emotional balance and lower the risk of stress-induced seizures by modulating brain activity in these areas.
Early research indicates that TMS may benefit patients with PNES by promoting more stable brain function and improving the efficacy of psychological therapies. Although TMS is still in the experimental stages for PNES, it shows promise as a future treatment option, especially for patients whose seizures are resistant to traditional therapies.
6. Eye Movement Desensitization and Reprocessing (EMDR): A Targeted Approach to Trauma
Eye Movement Desensitization and Reprocessing (EMDR) is already a well-established therapy for trauma and PTSD, and its effectiveness in the treatment of PNES is becoming more widely recognized, particularly in patients whose seizures are triggered by past trauma.
EMDR utilizes guided eye movements to assist individuals in processing traumatic memories and reducing their emotional impact. During an EMDR session, the patient is asked to recall a distressing memory while looking at the therapist’s hand or a light bar that moves back and forth. This process allows the brain to reprocess the memory in a less emotionally charged manner, thereby reducing the psychological distress associated with it.
For people with PNES, EMDR can help reduce the power of traumatic memories that may be causing seizures. Patients frequently report fewer episodes and greater emotional stability after reprocessing these memories. EMDR is most effective when combined with other therapies such as CBT and mindfulness.
7. Pharmacological Advances: Managing Co-Occurring Conditions
While anti-seizure medications are ineffective for PNES, new pharmacological strategies are being developed to treat co-occurring conditions that may exacerbate seizures. For example, new-generation antidepressants and anxiolytics are being investigated for their ability to treat underlying mood disorders, such as anxiety or depression, which are common in PNES patients.
Some new medications target neural pathways involved in emotional dysregulation, providing more tailored treatment for PNES patients who also suffer from mood disorders. Additionally, drugs that modulate the GABA and glutamate neurotransmitter systems are being investigated to help regulate the brain’s stress and emotional responses, thereby lowering seizure susceptibility.
While these pharmacological treatments are still in development, they provide hope for patients with complex PNES symptoms who may not respond well to psychotherapeutic interventions alone.
Holistic and Alternative Therapies for Psychogenic Non-Epileptic Seizures
Beyond traditional and emerging medical therapies, many people with Psychogenic Non-Epileptic Seizures (PNES) seek holistic and alternative treatments to improve their emotional well-being and better manage seizure episodes. These approaches frequently emphasize the mind-body connection and seek to promote overall health, resilience, and emotional balance.
1. Mindfulness Meditation Improves Emotional Awareness
Mindfulness meditation is a long-standing practice that encourages people to focus on the present moment, allowing them to become more aware of their thoughts and emotions without judgment. Individuals with PNES who cultivate this awareness can learn to identify the emotional or psychological triggers that cause seizures and develop healthier ways to manage their responses.
Mindfulness practices, including deep breathing and body scanning, have been shown to reduce stress and improve emotional regulation. These techniques can be especially beneficial for patients who have seizures in response to anxiety or emotional overwhelm. Regular mindfulness practice has been linked to fewer seizures and a stronger sense of emotional control.
2. Yoga and Tai Chi: Strengthening Mind-Body Connections
Yoga and Tai Chi are holistic practices that combine physical movement, breath control, and meditation to promote both mental and physical well-being. Both disciplines aim to improve the mind-body connection, which is especially important for people with PNES, in which emotional stress manifests physically as seizures.
- Yoga: Yoga, which incorporates gentle stretching, balance exercises, and mindful breathing, helps people improve their emotional resilience and reduce stress. Certain yoga practices, such as Restorative Yoga, emphasize relaxation and stress reduction, making them especially beneficial for patients with PNES.
- Tai Chi: This ancient Chinese practice consists of slow, flowing movements that are timed with deep breathing and mental concentration. Tai Chi encourages relaxation, balance, and emotional control, assisting patients with PNES in managing stress and avoiding emotional overload.
Both yoga and Tai Chi provide patients with non-invasive, empowering ways to manage their symptoms, making them excellent complementary treatments to traditional therapies.
3. Acupuncture: Balanced Energy for Emotional Stability
Acupuncture, a form of traditional Chinese medicine, involves inserting thin needles into specific points on the body to balance energy flow, or Qi. Acupuncture is thought to help regulate the body’s systems and restore balance, making it a popular holistic treatment option for patients with conditions like PNES, which combine emotional and physical symptoms.
Some patients report that regular acupuncture sessions help to reduce stress, improve emotional balance, and reduce the frequency of seizures. While scientific evidence for acupuncture’s effectiveness in treating PNES is limited, many people find it beneficial as part of a larger holistic treatment plan.
4. Nutritional Therapy: Improving Mental Health with Diet
A growing body of research suggests that diet and nutrition play an important role in mental health, and some people with PNES are looking into nutritional therapy as a way to improve their emotional well-being and reduce seizures. Nutritional therapy aims to ensure that patients get enough nutrients to support brain function and emotional regulation.
- Omega-3 Fatty Acids: Omega-3s, which can be found in foods like fatty fish, flaxseeds, and walnuts, are known for their anti-inflammatory properties and role in maintaining healthy brain function. Omega-3 supplementation may help regulate mood and improve emotional resilience in PNES patients.
- Magnesium and B Vitamins: Magnesium and B vitamin deficiencies have been linked to increased anxiety, depression, and stress, all of which can worsen PNES symptoms. Ensuring adequate intake of these nutrients through diet or supplementation can benefit overall mental health.
- Probiotics: Studies on the gut-brain connection suggest that probiotics, which are found in fermented foods such as yogurt and sauerkraut, may help improve mental health by promoting a healthy gut microbiome. According to some studies, gut health is closely linked to emotional balance, and including probiotics in the diet may benefit people with PNES.
5. Art Therapy: Creative Expression for Emotional Healing.
Art therapy offers individuals with PNES a unique and creative way to explore their emotions, process trauma, and express themselves in a nonverbal format. Patients who use art to express themselves can release pent-up emotions and gain insight into their psychological triggers.
Individuals can use painting, drawing, or sculpting to express stress, anxiety, or trauma that may be causing their seizures. Art therapy has proven particularly beneficial for people who struggle to express their emotions verbally, providing a therapeutic outlet for emotional processing.
