Could It Be PNES Instead of Epilepsy?

Epileptic Seizure or a Seizure-Like Episode?

When people hear the word seizure, they usually think of epilepsy. But the truth is that not all episodes are caused by epilepsy.

As a neurologist, one of the most important distinctions I help patients understand is the difference between epileptic seizures and PNES—Psychogenic Nonepileptic Seizures.

These events can look very similar from the outside, but their causes and treatments are completely different.

Understanding that difference can change a patient’s life.

PNES (Psychogenic Nonepileptic Seizures) are episodes that resemble epileptic seizures but are not caused by abnormal electrical activity in the brain.

Instead, they are considered a functional neurological disorder, meaning the brain is not structurally damaged but the way it functions is disrupted.

During an episode, a person may experience:

• Shaking or convulsions

• Loss of awareness

• Unusual body movements

• Emotional distress

• Collapse or unresponsiveness

From the outside, these symptoms can look almost identical to epilepsy.

This is why PNES is often misunderstood or misdiagnosed.

PNES are usually related to how the brain processes stress, trauma, or emotional overload.

The brain and body are deeply connected. When emotional or psychological distress becomes overwhelming, the brain may express it through physical symptoms.

Common contributing factors can include:

• Chronic stress

• Past trauma

• Anxiety or depression

• Emotional overload

• Difficult life transitions

It’s important to understand something very clearly:

• PNES episodes are real.

• They are not intentional, and they are not “fake.”

• Patients experiencing PNES are not pretending—the brain is responding to distress in a physical way.

The biggest reason PNES is misdiagnosed is simple:

The symptoms can look extremely similar to epileptic seizures.

Without proper testing, even experienced clinicians may initially suspect epilepsy.

That’s why neurologists rely on tools such as:

• Video EEG monitoring

• Detailed clinical history

• Neurological examination

During a video EEG, doctors can observe an episode while measuring the brain’s electrical activity.  If the brain’s electrical patterns remain normal during the event, it suggests PNES rather than epilepsy.

If you or someone you know experiences seizure-like episodes, it’s important to remember:

Not all seizures are epilepsy.

Proper neurological evaluation can make a critical difference in diagnosis, treatment, and long-term outcomes.

The brain is powerful—but it also needs the right support.