How to Support Someone With PNES: What to Do During and After a Functional Seizure
Watching someone experience a seizure-like episode can be frightening. You may feel helpless, worry that the person is in danger, or be unsure whether you should intervene.
When someone has psychogenic nonepileptic seizures (PNES)—also called functional seizures, non-epileptic event, or functional/dissociative seizures—the way family members, friends, teachers, coaches, and partners respond can make a meaningful difference.
Support does not mean ignoring the symptoms. It means recognizing that the episodes are real, protecting the person from injury, responding calmly, and helping them return to normal activities as safely as possible.
What Are Psychogenic Nonepileptic Seizures?
Psychogenic nonepileptic seizures are episodes that may involve shaking, unresponsiveness, staring, collapsing, altered awareness, or other seizure-like symptoms. Although they can resemble epileptic seizures, they are not caused by the abnormal electrical activity in the brain that defines epilepsy.
PNES are a subtype of Functional Neurological Disorder (FND). The symptoms are involuntary. The person is not consciously producing, pretending, or choosing to have an episode.
The International League Against Epilepsy has proposed the term functional/dissociative seizures to provide a more consistent and less stigmatizing description of these episodes (Hingray et al., 2025). Many clinicians and patients now use the term “functional seizures,” although PNES remains widely recognized.
A person may have functional seizures, epilepsy, or both. For this reason, seizure-like episodes should be evaluated by an appropriately qualified medical provider rather than diagnosed by family members or friends.
Why Your Response Matters
People with functional seizures frequently encounter disbelief, blame, embarrassment, and stigma. These experiences can increase isolation, make it harder to accept the diagnosis, and interfere with treatment.
Research involving young people and their parents has found that families value clear explanations, reassurance, compassion, practical guidance, and a concrete treatment plan. Families report more difficulty when symptoms are minimized, described with confusing medical language, or treated as though they are intentional (Patel et al., 2024).
Supportive communication is therefore not simply about being kind. It can influence whether the person feels safe seeking care and participating in treatment.
What to Do During a PNES Episode
The person should have an individualized response plan developed with their healthcare team. In the absence of different medical instructions, the following principles may help.
1. Remain Calm
Use a quiet, steady voice. Reduce noise, crowds, and visible panic when possible.
A calm response communicates safety. Yelling, repeatedly asking whether the person can hear you, or allowing a crowd to gather may increase distress.
2. Protect the Person From Injury
Move sharp, hard, or dangerous objects away. If the person is falling, help guide them to the floor when this can be done safely. Place something soft under their head if needed.
Do not restrain their arms or legs. Do not attempt to stop the movements.
3. Do Not Put Anything in Their Mouth
A person cannot swallow their tongue. Placing an object, food, water, or medication in the mouth during an episode can cause injury or choking.
4. Give Them Space and Privacy
Ask unnecessary bystanders to step away. Protect the person’s privacy, particularly if the episode occurs at school, work, during athletic activities, or in public.
One calm support person is often more helpful than several people talking at once.
5. Observe and Track the Episode
Note when the episode began, what occurred immediately beforehand, what the movements or behaviors looked like, and how the person recovered.
When the diagnosis remains under evaluation, a video may sometimes help the treating clinician distinguish among seizure types. Recording should be done only when the person is safe and in accordance with their previously discussed preferences. Smartphone videos can provide useful diagnostic information when reviewed by clinicians with appropriate expertise (Tatum et al., 2020).
6. Follow the Person’s Established Response Plan
Some people benefit from grounding prompts, such as noticing their surroundings, slowing their breathing, pressing their feet into the floor, or focusing on a familiar voice. Others may prefer minimal talking.
Ask the person and their treatment team what is most helpful before an episode occurs. Do not improvise intense breathing exercises, painful stimulation, or other techniques that have not been recommended.
7. Allow Time to Recover
After the episode, calmly orient the person to where they are and what happened. Avoid immediately interrogating them about stress, trauma, or why the seizure occurred.
Offer a quiet place to recover briefly. Once the person is medically safe and sufficiently alert, support a gradual return to ordinary activities when consistent with their treatment plan.
When Should You Call 911?
A known diagnosis of PNES does not mean that every future medical symptom should automatically be attributed to PNES.
Seek emergency assistance when:
This is the person’s first seizure-like episode.
The episode is substantially different from their established pattern.
The person has difficulty breathing, turns blue, or does not recover as expected.
A significant injury occurred.
The episode occurred in water.
There may be poisoning, overdose, severe illness, or another medical emergency.
The person’s individualized medical plan directs you to call.
You are uncertain whether the event is a functional seizure or another urgent condition.
Generic seizure first-aid guidance often recommends emergency assistance when an undiagnosed convulsive episode lasts longer than five minutes. However, some people with confirmed functional seizures have episodes that routinely last longer than this. Their neurologist or treatment team should provide individualized instructions that distinguish a typical functional seizure from a situation requiring emergency evaluation.
What Not to Do During a Functional Seizure
Do Not Accuse the Person of Faking
Functional seizures are involuntary. Calling the symptoms fake, manipulative, attention-seeking, or “all in your head” is inaccurate and potentially harmful.
Do Not Restrain the Person
Holding the person down can cause injuries and increase fear. Focus instead on clearing the surrounding area and maintaining safety.
Do Not Use Painful Stimulation
Do not pinch, slap, shake, press forcefully on the body, or use ammonia inhalants in an attempt to prove the person is conscious or stop the episode.
Do Not Automatically Administer Seizure Medication
Antiseizure medications treat epilepsy, not functional seizures. Some people have both conditions and may have prescribed emergency medication for epileptic seizures, so always follow the individualized medical plan.
The American Academy of Neurology recommends against prescribing benzodiazepines or antiseizure medications solely for functional seizures when there is no co-occurring epilepsy or another medical indication (Tolchin et al., 2026).
Do Not Create Unnecessary Alarm
Repeated ambulance calls, emergency department visits, or dramatic responses may be unnecessary for a person’s familiar episodes unless their medical response plan indicates otherwise. At the same time, never assume a new or medically concerning event is “just PNES.”
A written plan can reduce this uncertainty.
How to Support Someone Between PNES Episodes
Long-term support is as important as the immediate response.
Learn About PNES From Reliable Sources
Understanding that functional seizures are real, involuntary, and potentially treatable can reduce confusion and blame.
Education should also include the person’s specific symptoms, warning signs, triggers or vulnerability factors, grounding strategies, and emergency criteria.
Ask What Support Is Actually Helpful
Helpful questions may include:
“What helps you feel safe during an episode?”
“Would you like me to speak to you or stay quiet?”
“How can I help you return to what you were doing?”
“Who should I contact if something seems different?”
“What would make it easier to attend treatment?”
Avoid assuming that every person wants the same response.
Validate Without Reinforcing Helplessness
You can acknowledge the person’s distress without treating them as permanently fragile.
Helpful language may include:
“I believe that these symptoms are real.”
“You did not choose for this to happen.”
“We can follow your plan and help you stay safe.”
“I know recovery can take time.”
“What skill would be helpful right now?”
Try to avoid messages such as:
“You cannot handle anything stressful.”
“You should stop all activities until the seizures disappear.”
“Someone needs to watch you constantly.”
“There is no point trying because another episode might happen.”
Unless medically necessary, excessive restriction can reduce independence and make returning to school, work, sports, relationships, and community activities more difficult.
Encourage Treatment Without Forcing It
Evidence supports psychological interventions as a potentially effective component of functional-seizure treatment. Depending on the person, treatment may focus on recognizing warning signs, regulating the nervous system, changing unhelpful symptom expectations, improving coping, processing relevant experiences, addressing co-occurring conditions, and gradually returning to normal life.
Clinical trials have found that psychotherapy can improve several important outcomes, although treatment does not produce seizure freedom for everyone.
In the large CODES trial, cognitive behavioral therapy did not significantly improve the primary outcome of monthly seizure frequency compared with standardized medical care alone. However, it did improve several secondary outcomes, including quality of life, functioning, and the longest period without seizures (Goldstein et al., 2020).
A smaller randomized trial of cognitive behavioral therapy-informed psychotherapy found improvements in seizure frequency and several measures of mental health and functioning (LaFrance et al., 2014). For children and adolescents, early evidence also supports structured interventions tailored to developmental and family needs (Fobian et al., 2020).
Offer practical help, such as assisting with transportation, identifying specialists, organizing questions for appointments, or helping the person follow through with treatment. Avoid threats, ultimatums, or arguments intended to make them accept the diagnosis.
Support Care Coordination
Treatment may involve:
A neurologist or epileptologist
A therapist familiar with FND or functional seizures
A psychiatrist or prescribing clinician when indicated
A primary care provider
Physical, occupational, or rehabilitation professionals
School personnel, coaches, or workplace representatives
Family members or other trusted supports
The 2026 American Academy of Neurology guideline recommends continuity of care, evaluation for co-occurring epilepsy and psychiatric conditions, shared decision-making, and appropriate involvement of family members or caregivers in psychological treatment (Tolchin et al., 2026).
Help Create a Written PNES Response Plan
A written plan can include:
What the person’s typical episodes look like
Known warning signs
How to protect them from injury
Whether speaking or grounding prompts are helpful
How long episodes commonly last
What recovery usually looks like
When a support person should be contacted
When emergency services should be called
What school or work staff should do afterward
Who can answer medical questions
The plan should be individualized and reviewed by the person’s healthcare team.
Supporting a Child or Teen With PNES
For children and adolescents, caregiver involvement is often essential.
Parents may need to coordinate communication among neurology, therapy, primary care, school staff, and other adults. Pediatric consensus recommendations emphasize developmentally appropriate education, continued involvement from a clinician with epilepsy expertise after diagnosis, screening for mental health and neurodevelopmental concerns, and treatment decisions that consider the child’s age, cognitive abilities, and family circumstances (Reilly et al., 2023).
At school, the goal is usually to maintain safety while minimizing unnecessary disruption. Depending on the child’s plan, this may mean:
Training a limited number of staff members to respond
Moving other students away rather than moving the child unnecessarily
Avoiding routine ambulance calls for familiar episodes unless medically indicated
Offering a brief recovery period
Supporting return to class when safe
Preventing bullying or public discussion of the diagnosis
Maintaining academic expectations with reasonable accommodations
Avoiding unnecessary homebound education or activity restrictions
The child’s medical and mental health team should provide school-specific recommendations. A generic epilepsy seizure action plan may not adequately address functional seizures.
Take Care of Yourself, Too
Supporting someone with functional seizures can be emotionally and practically demanding. You may experience fear, frustration, exhaustion, guilt, or uncertainty about whether you are responding correctly.
It is appropriate to:
Ask the treatment team for education and clear instructions.
Set respectful limits around what support you can provide.
Maintain your own work, relationships, sleep, and activities.
Seek therapy or caregiver support when needed.
Avoid becoming the person’s only source of care.
Develop a shared plan instead of making decisions during each crisis.
Taking care of yourself is not abandoning the person. Sustainable support requires boundaries, teamwork, and realistic expectations.
Recovery Is Possible
Functional seizures can disrupt education, employment, relationships, independence, and confidence. Recovery is not always immediate or linear, and improvement should not be measured only by whether every seizure has stopped.
Meaningful progress may include:
Recognizing warning signs earlier
Using regulation or grounding skills
Experiencing shorter or less frequent episodes
Returning to school, work, sports, or social activities
Reducing emergency healthcare use
Improving quality of life
Treating co-occurring anxiety, depression, trauma symptoms, pain, or sleep problems
Feeling less afraid of symptoms
Becoming more independent
The most helpful supporters combine compassion with confidence: the symptoms are real, the person deserves respectful care, and improvement is possible.
Frequently Asked Questions
Are Psychogenic Nonepileptic Seizures Fake?
No. PNES are involuntary episodes associated with Functional Neurological Disorder. The person is not consciously producing the symptoms.
Is PNES the Same as Epilepsy?
No. Epileptic seizures are associated with abnormal electrical activity in the brain. Functional seizures are produced through a different mechanism. Some people can have both functional seizures and epilepsy.
Should I Call 911 Every Time Someone Has a PNES Episode?
Not necessarily when the person has a confirmed diagnosis and the episode follows their established pattern. Follow the individualized response plan.
Call for emergency assistance for a first episode, significant injury, breathing difficulty, an event in water, an unusual presentation, delayed recovery, or another reason to suspect a medical emergency.
Should I Talk to Someone During a Functional Seizure?
It depends on the person. Some people find a calm voice and simple grounding prompts helpful, while others prefer quiet. Discuss this in advance and document it in the person’s response plan.
Can Therapy Help PNES?
Psychological interventions may reduce episodes and improve functioning, quality of life, anxiety, and other symptoms. Treatment should be individualized and ideally coordinated with appropriate neurological care.
What Kind of Therapist Treats PNES?
Look for a licensed mental health professional with experience treating Functional Neurological Disorder, functional seizures, somatic symptoms, dissociation, or related mind-body conditions. The therapist should be willing to collaborate with the person’s medical providers.
Seeking Specialized Support for PNES
Ezer Psychotherapy provides specialized telehealth support for children, adolescents, young adults, and families navigating Functional Neurological Disorder, including psychogenic nonepileptic seizures.
Treatment may include:
Education about functional symptoms
Identification of warning signs and maintaining factors
Nervous-system regulation skills
Support with returning to school or daily activities
Parent and family guidance
Collaboration with medical providers when appropriate
To learn more about PNES and Functional Neurological Disorder treatment at Ezer Psychotherapy, contact the practice or request a consultation.
This article is for educational purposes and does not replace individualized medical advice, diagnosis, emergency instructions, or treatment. Anyone experiencing new or unexplained seizure-like symptoms should receive an appropriate medical evaluation.
References
Fobian, A. D., Long, D. M., & Szaflarski, J. P. (2020). Retraining and control therapy for pediatric psychogenic non-epileptic seizures. Annals of Clinical and Translational Neurology, 7(8), 1410–1419. https://doi.org/10.1002/acn3.51138
Goldstein, L. H., Chalder, T., Chigwedere, C., Khondoker, M. R., Moriarty, J., Toone, B. K., & Mellers, J. D. C. (2010). Cognitive-behavioral therapy for psychogenic nonepileptic seizures: A pilot RCT. Neurology, 74(24), 1986–1994. https://doi.org/10.1212/WNL.0b013e3181e39658
Goldstein, L. H., Robinson, E. J., Mellers, J. D. C., Stone, J., Carson, A., Reuber, M., et al. (2020). Cognitive behavioural therapy for adults with dissociative seizures (CODES): A pragmatic, multicentre, randomised controlled trial. The Lancet Psychiatry, 7(6), 491–505. https://doi.org/10.1016/S2215-0366(20)30128-0
Hingray, C., et al. (2025). Functional/dissociative seizures: Proposal for a new diagnostic label and definition by the ILAE task force. Epilepsia. Advance online publication.
LaFrance, W. C., Jr., Baird, G. L., Barry, J. J., Blum, A. S., Frank Webb, A., Keitner, G. I., et al. (2014). Multicenter pilot treatment trial for psychogenic nonepileptic seizures: A randomized clinical trial. JAMA Psychiatry, 71(9), 997–1005. https://doi.org/10.1001/jamapsychiatry.2014.817
McLoughlin, C., et al. (2024). Stigma in functional neurological disorder: A systematic review. Clinical Psychology Review, 111, 102440. https://doi.org/10.1016/j.cpr.2024.102440
Patel, H., et al. (2024). Youth and family perspectives on diagnosis communication about pediatric functional seizures: A qualitative study. Pediatric Neurology, 152, 52–59.
Reilly, C., et al. (2023). Scoping review and expert-based consensus recommendations for assessment and management of psychogenic non-epileptic seizures in children: A report from the Pediatric Psychiatric Issues Task Force of the International League Against Epilepsy. Epilepsia, 64(12), 3160–3195. https://doi.org/10.1111/epi.17768
Tatum, W. O., Hirsch, L. J., Gelfand, M. A., Acton, E. K., LaFrance, W. C., Jr., Duckrow, R. B., et al. (2020). Assessment of the predictive value of outpatient smartphone videos for diagnosis of epileptic seizures. JAMA Neurology, 77(5), 593–600. https://doi.org/10.1001/jamaneurol.2019.4785
Tilahun, B. B. S., & Bautista, J. F. (2022). Psychogenic nonepileptic seizure: An empathetic, practical approach. Cleveland Clinic Journal of Medicine, 89(5), 252–259. https://doi.org/10.3949/ccjm.89a.21069
Tolchin, B., Goldstein, L. H., Reuber, M., Stone, J., Perez, D. L., LaFrance, W. C., Jr., et al. (2026). Management of functional seizures practice guideline executive summary: Report of the AAN Guidelines Subcommittee. Neurology, 106(1), e214466. https://doi.org/10.1212/WNL.0000000000214466
