How to Respond to Psychogenic Non-Epileptic Seizures (PNES): A Complete Guide for Families, Caregivers, and Clinicians

What Are Psychogenic Non-Epileptic Seizures (PNES)?

Psychogenic Non-Epileptic Seizures (PNES), also known as functional seizures, are episodes that resemble epileptic seizures but are not caused by abnormal electrical activity in the brain. Instead, they are a manifestation of psychological distress and fall under the category of functional neurological symptom disorder (FND).

PNES are real, involuntary, and distressing—not faked or intentional. They often occur in individuals with underlying conditions such as:

• Anxiety disorders

• Depression

• Trauma or PTSD

• Eating disorders

• Chronic stress

Understanding how to respond appropriately is critical for safety, recovery, and reducing reinforcement of symptoms.

Why Your Response Matters

Your reaction during a PNES episode can either:

• Help reduce frequency and severity, or

• Unintentionally reinforce the behavior

The goal is to provide calm, supportive, and non-reinforcing care.

How to Respond During a PNES Episode (Step-by-Step)

1. Stay Calm and Grounded

Your demeanor sets the tone. Even if the episode looks severe, remaining calm helps de-escalate the situation.

Avoid:

• Panic

• Yelling

• Overly emotional reactions

Do not restrain the patient. It is best not to touch the patient or hover over them.

2. Ensure Safety First

Focus on preventing injury, just as you would with any seizure-like event.

Do:

• Move objects away

• Guide the person to the floor if needed

• Place something soft under their head

Do NOT:

• Restrain them

• Put anything in their mouth

• Attempt to stop movements forcefully

3. Reduce Attention and Stimulation

Unlike epileptic seizures, high levels of attention can unintentionally reinforce PNES episodes.

Helpful approach:

• Limit verbal interaction

• Avoid large crowds gathering

• Keep the environment quiet and low-stimulation

Think: present, but not overly engaged

4. Use Simple, Grounding Statements (If Appropriate)

If the person is partially responsive, gentle grounding can help:

• “You’re safe.”

• “I’m here.”

• “Focus on your breathing.”

Avoid complex instructions or emotional discussions during the episode.

5. Time the Episode

Tracking duration can be helpful for treatment planning.

• Most PNES episodes last longer than epileptic seizures

• Share timing data with treatment providers

6. Avoid Emergency Intervention Unless Necessary

Call emergency services only if:

• There is a serious injury

• The episode is significantly different than usual

• It lasts unusually long without recovery

• There are medical concerns (e.g., pregnancy, diabetes complications)

Frequent ER visits for typical PNES episodes can reinforce the cycle.

What to Do After a PNES Episode

1. Return to Normal Activities

One of the most important steps is not over-accommodating after the episode.

• Encourage returning to school, work, or daily routines

• Avoid excessive rest unless medically necessary

2. Provide Neutral Support (Not Excessive Reassurance)

Be supportive—but not overly nurturing in a way that increases attention to the episode.

Helpful:

• “Glad you’re back. Let’s get back to what we were doing.”

Avoid:

• Extended debriefs immediately after

• Overly emotional responses

• Special treatment or rewards tied to the episode

3. Do Not Punish or Blame

PNES are not intentional. Avoid:

• Criticism

• Accusations of “faking”

• Frustration directed at the individual

This damages trust and worsens symptoms.

4. Identify Triggers (Later, Not Immediately)

At a separate, calm time, explore patterns such as:

• Stress

• Social situations

• Academic pressure

• Family conflict

This should be done therapeutically—not during or right after the event.

What NOT to Do During PNES

Avoid these common mistakes:

❌ Calling 911 for every episode
❌ Providing excessive attention or physical comfort
❌ Allowing avoidance of responsibilities (e.g., school, meals, activities)
❌ Trying to “snap them out of it”
❌ Treating it exactly like epilepsy

Long-Term Management of PNES

Effective treatment focuses on addressing the underlying psychological and neurological factors.

Evidence-Based Treatments Include:

• Cognitive Behavioral Therapy (CBT)

• Trauma-focused therapy

• Family-based interventions

• Mindfulness and distress tolerance skills

• Treatment of co-occurring conditions (e.g., anxiety, eating disorders)

Consistency across caregivers, school staff, and clinicians is essential.

Special Considerations for Parents

If your child has PNES:

• Maintain clear expectations and structure

• Avoid letting seizures become a way to escape difficult tasks

• Collaborate with school staff for a consistent response plan

• Focus on functioning over symptom elimination

Special Considerations for Schools

Schools should:

• Have a response protocol that minimizes attention

• Avoid unnecessary nurse visits unless safety concerns exist

• Support quick return to class

• Coordinate with parents and clinicians

Key Takeaways

• PNES are real and treatable, but require a different response than epilepsy

• Stay calm, ensure safety, and minimize attention during episodes

• Return to normal functioning as quickly as possible afterward

• Consistency across environments is critical

• Treatment should target underlying psychological factors

If you or your loved one has psychogenic non-epileptic seizures, reach out for support today!