What is PNES?
Psychogenic nonepileptic seizures (PNES), or functional seizures, are events that look like epileptic seizures. They happen suddenly and may include a variety of symptoms. Unlike epileptic seizures, they are not caused by abnormal electrical activity in the brain. Although PNES may look scary, they do not hurt your child’s brain.
PNES can look different from child to child, and even from one event to the next.
Common symptoms:
- Shaking spells while still awake and aware
(e.g., your child’s arms and legs shake, but they can still hear you talking)
- Brief loss of awareness
(e.g., staring blankly or having their eyes closed and not remembering what happened)
- Movements that don’t match
(e.g., one arm jerks while the other stays still, or arms and legs move differently)
- Head shaking side-to-side
(like saying “no” over and over)
How common is PNES?
PNES is more common than many families realize. About 20-40% of people referred to epilepsy specialists are found to have PNES instead of epilepsy. Additionally, about 20% of people have both.
PNES usually begins during the teen years and young adulthood, though it can affect children as young as five. It is also about two to three times more common in girls than boys.
What causes PNES?
PNES is linked to the mind-body connection: how thoughts and feelings affect physical health, and vice versa. For example, stress can cause headaches, stomachaches, or trouble sleeping, which can then create even more stress. In the same way, stress may trigger seizure-like events, setting off a cycle where stress leads to more events.
PNES usually develops from a mix of biological, psychological, and social factors rather than a single cause. These might include chronic pain, poor sleep habits, excessive worry, stress, and/or changes in family or peer support.
How is PNES diagnosed?
Doctors will ask about your child’s events, including when they started, how often they occur, how long they last, and what happens right before them. If possible, bringing a video of an event can be very helpful.
To rule out epileptic seizures, doctors may use an electroencephalogram (EEG) to record brain activity. This is a painless test, involving placing small sticky discs (electrodes) on your child’s scalp. EEG’s may last anywhere from 20 minutes to several days to try to capture an event. If no abnormal brain activity is seen during an event, PNES may be diagnosed. If no event occurs, doctors usually rely on medical history to guide a diagnosis.
How is PNES treated?
If your child has PNES, anti-seizure medications will not help. The good news is that most children will get better with the right treatment. Care is sometimes provided through a multidisciplinary clinic, which might include: a pediatric neurologist (a doctor who treats the brain, spinal cord, and nerves), pediatrician, and integrated behavioral health specialist (e.g., psychologist). In other cases, the medical team may collaborate with your child’s current therapist or connect your family to a new therapist in the community.
Treatment often includes cognitive behavioral therapy (CBT) and/or retraining and control therapy (ReACT). Research shows that these therapies help children and families:
- Understand what triggers their events
- Learn healthy ways to cope when events happen
- Practice skills to have more control over their body during events
- Reduce how much the events affect daily life
- Build strong tools for managing stress
Working with your child’s school is also important. Educating teachers, counselors, and nurses about PNES helps them support your child and keep them feeling safe as they return to their normal routine.
There is no medication that directly prevents PNES. However, if your child also has anxiety, depression, or other mental health concerns, doctors may prescribe medicine to help manage those symptoms.
How do I support my child with PNES?
Hearing that your child has PNES can bring up many emotions, such as confusion, worry, frustration, or even relief. Some families are shocked if they first believed their child had epilepsy. Others may feel misunderstood or discouraged after a long search for answers. These reactions are normal. Remember: PNES symptoms are real, and they are not your or your child’s fault.
Parents play a key role in recovery. In fact, one of the strongest predictors of improvement is how well parents understand the diagnosis and its causes. By learning more, you are already helping their recovery- kudos to you for reading this blog!
Talk openly with your healthcare team by asking questions and sharing concerns. This can help improve your support system and understanding of PNES.
Helping your child day to day:
- Return to normal routine: Help your child get back to full school days and regular activities. Encourage healthy habits like eating regular meals, moving their body (e.g., 30-minute walk), and getting enough sleep (8-12 hours).
- Team up with the school: If events happen at school, work with teachers to create a 504 plan that supports your child. This may include allowing short breaks when your child notices warning signs and teaching school staff how to respond to events the same way you do at home. If an event happens in front of other students, ask teachers to calmly explain that the event is not dangerous and guide students back to their work to avoid unhelpful attention.
- Stay connected: Encourage strong relationships with family and friends.
- Encourage practice: Praise your child for working hard in therapy and help them use their new skills at home.
- Stay calm during events: Remind yourself and your child that PNES is not harmful. You can say things like, “You were okay after your last event, and you’ll be okay after this one too.” Practice deep breathing together to help them relax (e.g., Inhale 4 seconds, hold 4, exhale 4, hold 4, and repeat).
Proper Citation for this blog post:
Sneesby, M., & Keane, S. P. (June 02, 2026). When seizures aren’t epilepsy: Helping your child with PNES.
https://infoaboutkids.org/blog/when-seizures-arent-epilepsy-helping-your-child-with-pnes/
