Psychogenic Nonepileptic Seizure (PNES)

Researchers believe PNES is a type of conversion disorder. This means your brain turns, or converts, mental health symptoms like stress into physical symptoms. The symptoms are real and can be part of the brain’s defense mechanism against underlying stress from unresolved or untreated conditions like:

• Post-traumatic stress disorder (PTSD).
• Depression.
• Dissociative disorders.
• Somatic symptom disorder.
• Personality disorders.
• Adverse childhood experiences.
• Chronic pain.
• Fibromyalgia.

Epileptic and psychogenic nonepileptic seizures can look alike. When you have PNES, you may have similar convulsive movements and or stare straight ahead with unresponsiveness (absence seizures) just like epilepsy. It can often be hard to tell them apart.

But there are signs we look for to confirm that your seizures might be psychogenic. PNES don’t respond to traditional epileptic seizure treatments. And with this condition, tests will likely show normal signals (electrical activity) in your brain. That’s why it’s important to get an evaluation from healthcare providers experienced with diagnosing and treating seizures.

What to expect during your evaluation

When you come to your appointment, you’ll want to be ready to answer a lot of questions about what you’ve been experiencing. Your provider may ask:

• When did you start having seizures?
• How many seizures have you had?
• How long do the seizures last?
• What symptoms come with your seizures?
• Have you been diagnosed with any health conditions?
• What health conditions do family members have?

Testing for psychogenic nonepileptic seizures

To rule out other conditions, your provider may do physical and neurological exams. You may also have neuropsychological testing.

A video EEG (electroencephalogram) is the most reliable way to confirm psychogenic nonepileptic seizures. The test measures and records your brain’s electrical signals. If we see normal activity while you’re having seizures, then we can move toward a PNES diagnosis.

Meet Our Psychogenic Nonepileptic Seizure (PNES) Team

We believe it takes a team to deliver the best possible care and results. Why? Because health conditions often affect your body in different ways. So, if you choose Cleveland Clinic for PNES care, we build a personalized care team for you. You’ll have providers like:

• Neurologists.
• Neuropsychologists.
• Neurophysiologists.
• Psychiatrists.
• Psychologists.
• Social workers.

This team and other providers work together to confirm a diagnosis, plan your care and guide you through treatment.

The frontline treatment for PNES is a type of psychotherapy (talk therapy) called cognitive behavioral therapy (CBT). We find it to be the most effective option in treating PNES and conversion disorders. Your sessions will include learning more about your seizures and their triggers (stressors) and how to manage your emotions and stress. You may also do relaxation training as part of these appointments.

We may also treat underlying conditions with other types of therapy and medications. How we approach this depends on what type of conditions you have. If you have depression, you may take antidepressants. Or if you have a personality disorder, you may do dialectical behavior therapy (DBT). Your care team will go over the best treatments for any underlying conditions with you.

Taking the Next Step

Talking about mental health conditions and seizures can be hard to do. When you start thinking about what’s next, look no further than Cleveland Clinic. We’re here to listen compassionately and help you move forward with the expert treatment you deserve. Getting care for PNES can be a journey. And we’ll be by your side throughout it all.