Canadian League Against Epilepsy

Psychogenic Non-Epileptic Seizures (PNES)

The term Psychogenic Non-epileptic Seizures (PNES) is used to describe attacks that may, in one way or another, resemble epileptic seizures but are not due to epilepsy. The term psychogenic is used to differentiate PNES from other epilepsy mimickers such as fainting, migraine headaches, sleep disorders, or transient ischemic attacks (warning strokes). People with PNES are not “faking” these attacks.

Epilepsy is a condition in which the clinical manifestations of seizures are associated with abnormal excessive electrical discharges on the electroencephalogram (EEG) that are characteristic of that condition. The EEG in persons with PNES does not show any evidence of seizure activity during an attack.

The mechanisms and causes of PNES are not well understood. One concept is that PNES is a body-mind-disconnection syndrome. The events are thought to arise from the unconscious expression of underlying psychological traumas or from disruption of a person’s independence or self-confidence, for example. These events often have a poor prognosis if not treated early and appropriately (e.g., with long-term psychotherapy). PNES should be distinguished from events that are intentionally produced for secondary gain.

Adolescent and young adults, especially females, are known to be at higher risk of having PNES but this condition is not limited to these groups. Physical, verbal and, in particular, sexual abuse in early childhood are known to be strong risk factors for developing PNES.

PNES are common and often difficult to differentiate from true epileptic seizures. PNES may also occur in persons with epilepsy, making the diagnosis and management even more difficult. Importantly, PNES should be recognized because antiseizure drugs do not work to alleviate them. A wrong diagnosis may lead to an escalation of prescriptions and to medication side effects, while not improving the patient’s underlying condition.  A reliable diagnosis of PNES requires continuous video-EEG monitoring under medical supervision.

The prognosis of patients with PNES is variable but can be good when managed by a skillful team.

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