Non-epileptic seizures look like epileptic seizures, with shaking, unresponsiveness, or unusual movements, but they aren’t caused by the abnormal electrical activity in the brain that defines epilepsy. The causes fall into two broad categories: functional (driven by how the brain processes stress and emotion) and physiological (triggered by a separate medical condition like a heart problem or blood sugar imbalance). The functional type is far more common, and understanding what drives it has changed significantly in recent years.
Functional Seizures vs. Physiological Seizures
The term “non-epileptic seizure” is an umbrella that covers very different problems. Functional seizures, sometimes called dissociative seizures or psychogenic non-epileptic seizures (PNES), are episodes where the brain’s emotion-processing systems disrupt normal sensory and motor function. They are now formally classified as part of functional neurological disorder (FND). These are not “fake” seizures. They are involuntary, and the person experiencing them has no conscious control over the episode.
Physiological non-epileptic events, on the other hand, have a clear medical trigger. Fainting from a heart rhythm problem, episodes caused by very low blood sugar in diabetes, or events related to other metabolic disturbances can all mimic seizures. These are typically identified and managed by treating the underlying condition. The rest of this article focuses on functional seizures, since they are what most people are searching about and the hardest to pin down.
How the Brain Produces Functional Seizures
For a long time, functional seizures were poorly understood and often dismissed. Current research frames them as brief episodes triggered by an unstable system for managing emotion and attention. In simple terms, the parts of your brain that handle emotions and the parts that control movement and sensation lose their normal coordination. When that happens, pre-wired physical responses, like shaking, stiffening, or going limp, can deploy on their own without any conscious decision.
Brain imaging studies have started to reveal what this looks like structurally. Research presented through the American Epilepsy Society found that people with functional seizures show an unusual asymmetry in the wiring between the front of the brain (involved in decision-making and regulation) and deeper emotional centers. Specifically, they had significantly more connecting fibers on the right side of the brain compared to the left, a pattern not seen in healthy controls. This kind of finding supports the idea that functional seizures aren’t simply “psychological” in the vague sense. There are measurable differences in how the brain is wired for emotional processing.
What triggers an individual episode varies. It could be a stressful conversation, a sensory overload, a reminder of a past trauma, or sometimes no identifiable trigger at all. The key point is that the brain’s ability to tolerate arousal and regulate its own emotional responses is compromised, making seizures more likely under conditions that most people’s brains would handle without producing physical symptoms.
The Role of Trauma and Psychological Stress
Trauma is the single most studied risk factor for functional seizures. Studies report that anywhere from 25% to 100% of patients with functional seizures have experienced significant psychological trauma, depending on the population studied. In one structured interview study of 67 patients with pure functional seizures, about 73% recalled traumatic events. Roughly a third of those patients met criteria for post-traumatic stress disorder (PTSD).
Childhood abuse, sexual assault, combat exposure, and serious accidents are all commonly reported. But trauma alone doesn’t explain every case. Some people develop functional seizures without any identifiable traumatic history. Other contributing factors include ongoing life stress, anxiety disorders, depression, and personality traits associated with difficulty processing emotions. Many patients have more than one of these factors stacking on top of each other.
It’s worth emphasizing that having a trauma history doesn’t mean a person is “making up” their seizures or that the seizures are a form of attention-seeking. The current model views functional seizures as a physical expression of a brain that has been shaped, often by difficult experiences, to process stress in a way that produces real neurological symptoms.
Why Diagnosis Takes So Long
One of the most striking facts about functional seizures is how long people live with them before getting the right diagnosis. The average time from the first seizure to a correct diagnosis is about 5.6 years, with a median of 3 years. Some patients wait decades. Previous studies have reported average delays of 5 to 7 years, and in some cases up to 11 years.
During that gap, many patients are treated as though they have epilepsy. They may take anti-seizure medications that don’t work and carry side effects, visit emergency rooms repeatedly, and face restrictions on driving or employment. The gold standard for diagnosis is video-EEG monitoring, where brain activity is recorded during an actual episode. If the EEG shows no epileptic discharge during a seizure, functional seizures become the leading diagnosis.
Complicating things further, about a third of people with functional seizures also have genuine epilepsy. One large study found that confirmed co-occurrence of epilepsy and functional seizures was present in roughly 33% of patients with functional seizures, and when probable cases were included, that figure rose to over 50%. This overlap makes it especially difficult to sort out which episodes are epileptic and which are functional, and it’s a major reason the diagnostic delay is so long.
What Treatment Looks Like
Because functional seizures are not caused by abnormal electrical brain activity, anti-seizure medications used for epilepsy do not help. Treatment instead focuses on the underlying mechanisms: how the brain processes emotion, how the body responds to stress, and how the person understands what is happening to them.
Cognitive behavioral therapy (CBT) adapted for functional seizures is the most studied treatment. A meta-analysis of randomized controlled trials found that people who received CBT were roughly twice as likely to become seizure-free compared to those who received standard medical treatment alone. Broader reviews of psychological interventions have shown that at least half of treated patients achieve a 50% or greater reduction in seizure frequency.
The therapy typically involves learning to recognize early warning signs before a seizure, developing strategies to manage emotional arousal, and gradually retraining the brain’s response to triggers. For people with co-occurring PTSD, trauma-focused therapy may be an important part of the picture. Some patients also benefit from physical therapy approaches that help them regain confidence in their body’s movements and sensations.
Getting the diagnosis itself is often therapeutic. Many patients describe relief at finally having a name and explanation for what they’ve been experiencing, especially after years of being told their brain scans look normal or that their seizures don’t fit the expected pattern. Understanding that the condition is real, recognized, and treatable changes the trajectory for a lot of people.