Nonepileptic Events

Nonepileptic events (NEE) are common and resemble epileptic seizures. Abnormal brain electricity that causes epileptic seizures does not cause them. And we do not treat them in the same way. We call the episodes “nonepileptic events” to avoid confusing them with the seizures we see in epilepsy, since they respond to different treatments. NEE:

• Can be seen in people who also have epilepsy but do not have the same cause.
• Are usually not voluntary (the person is not “faking” or “doing it on purpose”).
• Can cause behavioral changes that look very similar to epileptic seizures.
• Can be a physical symptom of stress, but the stressful situation does not need to be currently ongoing. 
• It can also be seen as a physical symptom of anxiety, depression and other mental health conditions.
• Can be seen in otherwise healthy people as well as people with other medical or neurological conditions, such as autism.

Other names for nonepileptic events include:

• Pseudoseizures
• Psychogenic nonepileptic seizures (PNES)
• Nonepileptic seizures (NES)
• Psychogenic nonepileptic events
• Nonepileptic attacks
• Functional seizures
• Stress seizures
• Behavioral events

The behaviors and length of events vary from person to person. They can resemble epileptic seizures or other neurological conditions so closely that EEG testing is needed to confirm the diagnosis. These behaviors may include: 

• Generalized jerking or muscle twitching
• Loss of consciousness
• Unresponsive staring
• Emotional numbness (dissociation)
• Muscle jerks
• Loss of feeling (numbness)
• Weakness
• Difficulty walking
• Difficulty speaking or hearing
• Dizziness

• Your neurologist diagnosed you based on the description of events, medical history, a neurological exam and test results.
• The most common test is the electroencephalogram (EEG). It is a painless measurement of your brainwaves using electrodes placed on your scalp. 
• Depending on your symptoms, your neurologist may order other tests to investigate other possible causes.

• We think many nonepileptic events are triggered by stress. The brain controls the way the body reacts to emotions. People in stressful situations can feel worried or afraid and may have a physical response like difficulty breathing, shaking hands, inability to move, nervous energy (butterflies in the stomach), headaches or sweating.
• These feelings are caused by the brain and body releasing stress chemicals such as adrenaline (epinephrine). When the situation is over, the body returns to normal. Nonepileptic events are often an uncommonly strong physical response to a stressful situation. These are not under your control, just like blushing when you are embarrassed.
• Peer pressure and adult expectations can be especially stressful for both neurotypical and neurodivergent children and teens. The way other people respond to nonepileptic events can also influence how severe and frequent events are, so treatment also involves discussing how best to respond to events when they happen.

• In some people with nonepileptic events, we find they have had a clear recent emotional trauma or stressor that may have triggered the nonepileptic event, such as a death in the family or surviving a school shooting. In other people, the stressor occurred months or years earlier. 
• Sometimes the stressor is not a single stressful event, but a continuous high level of stress, such as school or online bullying, chronic illness or family conflicts.
• In some people, we can’t identify the stressor. You do not need to have a history of stressful events to experience nonepileptic events or receive that diagnosis.

People with nonepileptic events may also have depression and anxiety. Mental health conditions may contribute to the symptoms, but they are separate diagnoses. We want to identify and treat these conditions if you have them. See our handouts:

• “Depression: Facts for Families” 
  seattlechildrens.org/pdf/PE1287.pdf
• “Anxiety: Facts for Families”
  seattlechildrens.org/pdf/PE1492.pdf

Age is not a risk factor. Nonepileptic events can start at any stage in life.

People who are more likely to experience nonepileptic events include:

• Girls more than boys
• People with a history of trauma, such as abuse, bullying or loss
• People who have known strong physical reactions to stress (like stomach aches, difficulty breathing and headaches)

• Parents should talk with their child’s therapist and neurologist about what to do during the event. You should provide this plan in writing to schools if the events happen there.
• For most people, the events have a recognizable aura or prodrome (symptoms that warn that an event is about to happen). Once you identify this aura, you can shorten many types of nonepileptic events by moving the person to a safe, low-stimulus area without onlookers like a dark, quiet room.

A specific kind of talk therapy called cognitive-behavioral therapy (CBT) is the main treatment for nonepileptic events. Therapy can help you:

• Learn stress and anxiety management techniques like deep breathing, biofeedback or other natural methods to manage the strong physical symptoms of nonepileptic attacks.
• Identify stressors or triggers to learn how to stop these events early when the symptoms are mild.

• Find a therapist in your area who practices cognitive-behavioral therapy (CBT) and has experience working with people who have nonepileptic events and their families. If you need a referral, contact your primary care doctor. Once you have a therapist, you can sign a release of information at their office, so they can request medical records from us.
• For more information, read our handout, “How to Find a Therapist.”
  seattlechildrens.org/pdf/PE2195.pdf

Your primary care doctor or psychiatrist may suggest medicines if your child has anxiety or depression. Seizure medicines (anticonvulsants) do not help.

Driving safely with nonepileptic events is a complex issue since triggers can be unpredictable. Talk with your neurologist. Consult your state laws for more information.

Yes. There is no instant cure for these events, but most people do improve over time. Nonepileptic events may stop completely, or they may become less frequent or less intense over time. Children and teenagers often respond well to treatment for nonepileptic events, especially if it’s soon after diagnosis. Working with a therapist or psychiatrist is more likely to result in success in stopping the events.

Work with your child to understand and accept the diagnosis.

• Ask for help from their schools.
• Be patient with your child’s nonepileptic events.
• Know that nonepileptic events are not under their control and can get better over time.
• Attend family therapy or counseling sessions with your child if stress or conflict may be triggering these events.

What and who to tell is a very personal decision. Here are some suggestions: 

• Healthcare providers need to know up-to-date medical information, including this diagnosis, to provide the best care.
• Sharing the diagnosis with friends, family, and people at school and work can help them understand and provide support. Let them know this is a real medical condition that can look like a seizure, what happens, and what they should do during an event (the plan made with your doctor or therapist). You might also share that it is expected to get better with treatment.

• Nonepileptic Seizures or Events
  epilepsy.com/diagnosis/imitators-epilepsy/psychogenic-nonepilepticseizures 
• Functional (Dissociative) Seizures
  neurosymptoms.org

To get help when a therapist is not available, be ready to contact your local crisis line. Consider adding your local number to your cellphone or household emergency contact list for quick access in an emergency.

Western Washington contacts:

• King County: 1-866-427-4747, crisisconnections.org (formerly Crisis Clinic) 
• Snohomish County: 1-800-584-3578 
• Pierce County: 1-800-576-7764
• Kitsap County: 1-800-843-4793
• Yakima County: 1-800-572-8122 

Find a Helpline (formerly suicide hotlines): choose United States, then choose your state.

• Findahelpline.com