Dissociative Non-epileptic Seizures

Dissociative (non-epileptic) seizures are episodes that look and feel like epileptic seizures, but are not caused by abnormal electrical activity in the brain. They are also known as functional or dissociative seizures and are understood as a type of Functional Neurological Disorder (FND).

During an episode, a person may lose awareness, collapse, shake, or become unresponsive. These seizures are real, involuntary and can be very distressing, but they do not cause structural damage to the brain.

At The Royal Buckinghamshire Hospital, we support adults who experience dissociative seizures as part of a wider picture of FND, complex neurological symptoms, pain, fatigue or cognitive difficulties, providing specialist inpatient neurorehabilitation to help people regain function and confidence.

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Causes of Dissociative (Non-Epileptic) Seizures

Dissociative seizures are thought to arise from a problem with how the brain processes and responds to thoughts, emotions, memories and bodily sensations, rather than from a structural brain lesion or epilepsy.

Possible contributing factors include:

• Exposure to stressful or traumatic events, past or present
• Long-term emotional distress, anxiety or depression
• Previous physical illness, injury, pain or epilepsy
• Difficulties with emotional regulation or dissociation (feeling disconnected from oneself or surroundings) Mind+2Oxford Health NHS Foundation Trust+2
• Sleep disturbance, fatigue or other health conditions

The seizures are not deliberate, and people are not “putting them on”. The episodes happen unconsciously, outside the person’s control.

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Other Names You May Hear

You may come across several terms that all refer to the same type of seizure, including:

• Non-epileptic seizures (NES)
• Non-epileptic attack disorder (NEAD)
• Psychogenic non-epileptic seizures (PNES)
• Functional seizures
• Dissociative seizures
• Non-epileptic attacks

These terms can be confusing. The key point is that dissociative / functional seizures are real seizures, but they are functional in nature (a “software” problem with brain function), rather than epileptic (a “hardware” problem with electrical activity).

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Common Symptoms of Dissociative (Non-Epileptic) Seizures

Symptoms vary between individuals, and the same person may experience more than one seizure type.

Episodes may include:

• Sudden collapse or loss of awareness
• Shaking, jerking or thrashing movements of the arms, legs or body
• Going very still and unresponsive, sometimes with eyes closed
• Staring or fixed gaze, not responding to people nearby
• Changes in breathing, vocal sounds or crying during or after the event
• Loss of memory for part or all of the episode
• Feeling very tired, confused, tearful or emotionally overwhelmed afterwards

Some people notice warning signs such as dizziness, changes in vision or hearing, a rising sense of fear or detachment, or physical sensations in the chest or stomach before an episode occurs.

Dissociative seizures can be frequent and prolonged, and it is possible for a person to have both epileptic and non-epileptic seizures, which can complicate diagnosis.

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How Dissociative Seizures Are Diagnosed

Diagnosing dissociative (non-epileptic) seizures usually involves assessment by a neurologist or specialist epilepsy service. The aim is to:

• Take a detailed history of the events and any triggers
• Ask witnesses to describe what happens during a typical episode
• Review home video recordings of seizures where available
• Perform tests to rule out epilepsy and other medical causes, which may include:
  • Electroencephalogram (EEG) or video-EEG monitoring during events
  • Brain imaging (such as MRI) if needed
  • Blood tests and cardiac investigations where appropriate

A diagnosis of dissociative / functional seizures is made positively, based on typical clinical features and investigations, rather than by exclusion alone. Once epilepsy and other serious causes have been excluded, a clear explanation of functional seizures as a form of FND is essential to effective treatment.

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Treatment and Management

The main focus of treatment is to help the brain and body respond differently to stress, emotions and bodily sensations, and to reduce the frequency and impact of seizures. Anti-epileptic medications are not effective for dissociative seizures unless someone also has epilepsy.

Treatment plans may include:

• Clear education about the diagnosis and FND, so that the seizures are understood as real but functional symptoms
• Psychological therapies (such as cognitive behavioural therapy and trauma-focused approaches) to address triggers, stress, trauma, anxiety, low mood or dissociation
• Strategies to manage early warning signs, reduce avoidance and gradually rebuild confidence in daily activities
• Physiotherapy and occupational therapy to address co-existing functional movement problems, fatigue or balance issues
• Support for families and carers, helping them respond calmly and safely to seizures and encourage independence

Recovery differs between individuals, but many people can achieve fewer seizures, shorter episodes and improved quality of life when the diagnosis is understood and appropriate treatment is in place.

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Dissociative Seizures and Functional Neurological Disorder (FND)

Functional (dissociative) seizures are recognised as a type of Functional Neurological Disorder (FND). Many people with dissociative seizures also experience other FND symptoms, such as:

• Functional limb weakness or gait problems
• Functional tremor or abnormal movements
• Sensory changes (numbness, tingling, visual disturbances)
• Functional cognitive symptoms (e.g. “brain fog”)
• Chronic pain, fatigue or sleep disturbance

Because of this overlap, multidisciplinary FND rehabilitation can be helpful, particularly when seizures sit within a broader pattern of neurological and physical difficulties.

You can read more on our dedicated pages:

• Functional Neurological Disorder (FND) – Conditions & Symptoms page The Royal Buckinghamshire Hospital
• Functional Neurological Disorder – Inpatient Rehabilitation – Rehab Centre page The Royal Buckinghamshire Hospital

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How We Can Help at The Royal Buckinghamshire Hospital

At The Royal Buckinghamshire Hospital, we support adults with dissociative (non-epileptic) seizures as part of FND or complex neurological presentations, particularly where symptoms significantly affect daily life, independence and confidence.

Our consultant-led inpatient neurorehabilitation programmes may include:

• Neurophysiotherapy
  To improve movement, balance, strength and coordination, and to rebuild confidence in standing, walking and everyday activity.
• Occupational therapy
  To support energy management, daily living skills, routine, graded return to work or study, and engagement in meaningful activities.
• Clinical neuropsychology and psychology
  To provide education about FND and dissociative seizures, address trauma, anxiety or low mood, and develop practical strategies for managing triggers and early warning signs.
• Speech and language therapy (where needed)
  To support communication, cognition or functional speech issues linked with FND.
• Education and self-management support
  For patients and families, focusing on understanding the condition, responding to seizures safely and promoting long-term self-management.

When to Consider Inpatient Neurorehabilitation

Inpatient FND-focused rehabilitation may be helpful if:

• Dissociative seizures are frequent, prolonged or disabling, affecting your ability to work, study or manage at home
• You experience other functional neurological symptoms, such as gait difficulties, limb weakness or sensory changes
• Investigations have ruled out epilepsy or structural brain disease, but symptoms persist and are hard to manage
• You are struggling with fatigue, pain, cognitive difficulties or emotional changes on top of your seizures
• Community treatment alone has not provided sufficient improvement

Our team will work with you to understand your goals and to decide whether an inpatient programme at Royal Bucks is appropriate for your needs.

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When to Seek Urgent Medical Help

This page provides general information and is not a substitute for emergency medical care.

You should seek urgent medical help (999 / emergency department) if someone:

• Has a seizure for the first time
• Has a seizure lasting longer than 5 minutes or has repeated seizures without recovery between them
• Has difficulty breathing or severe chest pain
• Is injured during the episode (for example, a head injury or severe fall)
• Does not regain awareness as expected after an episode

For ongoing management of known dissociative or functional seizures, discuss your care with your GP, neurologist or epilepsy / FND service, who can advise on referral pathways and whether a rehabilitation programme such as ours may be suitable.