Moderate

Quasi‑Seizure - Causes, Treatment & When to See a Doctor

📅 Updated: May 2026 ⏱️ 5 min read ✅ Medically reviewed

Contents

```html Quasi‑Seizure: Causes, Symptoms, Diagnosis & Treatment

Quasi‑Seizure: A Patient‑Friendly Guide

What is Quasi‑Seizure?

A quasi‑seizure (also called a psychogenic non‑epileptic seizure, PNES) is an event that looks like an epileptic seizure but is not caused by abnormal electrical activity in the brain. Instead, the episode originates from psychological or emotional factors and involves the brain’s normal circuitry. Because the outward signs—staring, shaking, loss of motor control—can be indistinguishable from a true seizure, a careful medical evaluation is needed to differentiate the two.

Quasi‑seizures are classified under the umbrella of functional neurological disorders (FND). They are real, involuntary events; patients are not “faking” or seeking attention. The International League Against Epilepsy (ILAE) defines PNES as “a clinical event that resembles an epileptic seizure but lacks the electro‑physiological correlates of epilepsy.”1

Common Causes

Quasi‑seizures are multifactorial. The following conditions are most frequently associated with PNES:

  • Psychological trauma – past abuse, accidents, or combat exposure.
  • Stressful life events – divorce, job loss, or financial crises.
  • Depressive disorders – major depressive disorder, dysthymia.
  • Anxiety disorders – generalized anxiety, panic disorder, post‑traumatic stress disorder (PTSD).
  • Conversion disorder – a somatic symptom that converts psychological distress into neurological signs.
  • Personality disorders – especially borderline personality disorder.
  • Somatic symptom disorder – excessive focus on physical symptoms without a clear medical cause.
  • History of epilepsy – patients with epilepsy can develop PNES, often as a coping mechanism for seizure‑related anxiety.
  • Substance use – alcohol withdrawal, benzodiazepine dependence, or recreational drug use can trigger episodes.
  • Medical conditions that affect the nervous system – migraines, head injury, or autoimmune encephalitis can coexist and increase the risk of functional seizures.

Associated Symptoms

While the core event mimics an epileptic seizure, other features frequently appear before, during, or after the episode:

  • Rapid onset of intense emotions (fear, shame, anger).
  • Pre‑ictal symptoms such as a “rising” sensation in the abdomen, déjà vu, or a feeling of impending doom.
  • Prolonged post‑ictal fatigue that is less severe than that seen after a true seizure.
  • Variable seizure length (often longer than typical epileptic seizures).
  • Resistance to anti‑seizure medications.
  • Fluctuating motor patterns—e.g., side‑to‑side shaking that changes direction.
  • Preserved awareness or partial awareness (patients may answer questions during the event).
  • Physical signs such as crying, vocalizations, or resistance to eye opening, which are uncommon in epileptic seizures.

When to See a Doctor

Because distinguishing PNES from epilepsy is critical for appropriate treatment, seek medical help promptly if you experience any of the following:

  • First‑time seizure‑like event, regardless of appearance.
  • Episodes that last longer than 2–3 minutes or recur frequently.
  • Seizure‑like activity after a head injury or stroke.
  • New neurological symptoms (weakness, speech difficulty) that accompany the event.
  • History of mental health conditions with a recent change in symptoms.
  • Persistent confusion, difficulty breathing, or loss of consciousness that lasts more than a few minutes.

Early evaluation can prevent unnecessary anti‑seizure medication use and allow timely mental‑health intervention.

Diagnosis

Diagnosing quasi‑seizure involves a combination of clinical assessment, electro‑diagnostic testing, and sometimes psychological evaluation.

1. Detailed History & Physical Examination

  • Temporal pattern of events, triggers, and prodromal sensations.
  • Medication review (including over‑the‑counter and recreational drugs).
  • Psychosocial history – trauma, stressors, and psychiatric diagnoses.

2. Electroencephalogram (EEG)

A standard or video‑EEG monitors brain electrical activity during an episode. In PNES, the EEG remains normal throughout the event, whereas epileptic seizures show characteristic ictal discharges.2

3. Video‑EEG Monitoring (VEM)

The gold‑standard test. Patients are observed continuously for several days in a specialized unit. Correlating video of the clinical event with the EEG provides decisive evidence.

4. Neuroimaging

  • MRI of the brain to rule out structural lesions (tumors, cortical dysplasia).
  • CT scan if MRI is contraindicated.

5. Psychiatric Assessment

A mental‑health professional evaluates for underlying disorders such as PTSD, depression, or conversion disorder. Validated tools like the Structured Clinical Interview for DSM‑5 (SCID) are often used.

6. Laboratory Tests

Basic labs (CBC, electrolytes, thyroid function) help exclude metabolic causes that can mimic seizures.

Treatment Options

Effective management requires a multidisciplinary approach—neurology, psychiatry/psychology, and primary care.

1. Education & Reassurance

  • Explain that PNES are real, involuntary events not caused by “being fake.”
  • Provide written material and a clear diagnosis letter to share with other healthcare providers.

2. Psychotherapy

  • Cognitive‑behavioral therapy (CBT) – the most evidence‑based approach; helps patients identify triggers, develop coping skills, and reduce seizure frequency.3
  • Dialectical behavior therapy (DBT) – beneficial for those with borderline personality features or severe emotion dysregulation.
  • Trauma‑focused therapies – EMDR (eye‑movement desensitization and reprocessing) for PTSD‑related PNES.

3. Pharmacotherapy

  • Antidepressants (SSRIs, SNRIs) for comorbid depression or anxiety.
  • Atypical antipsychotics may help when severe emotional lability is present.
  • Medication is NOT a primary treatment for PNES itself but addresses co‑existing psychiatric illness.

4. Stress‑Reduction & Lifestyle Strategies

  • Regular aerobic exercise (30 min most days) improves mood and reduces stress hormones.
  • Mindfulness‑based stress reduction (MBSR) or meditation.
  • Sleep hygiene – aim for 7‑9 hours, consistent bedtime routine.

5. Follow‑up & Coordination of Care

  • Regular neurology visits to monitor for any emergence of true epileptic seizures.
  • Psychiatric/psychology appointments every 2–4 weeks initially, tapering as symptoms improve.
  • Family education to avoid reinforcement of seizure‑like behavior (e.g., excessive attention during episodes).

Prevention Tips

While a single episode may be unavoidable, the frequency and severity of quasi‑seizures can often be reduced:

  • Identify personal triggers – keep a diary of events, stressors, sleep patterns, and diet.
  • Implement coping mechanisms – deep‑breathing, grounding techniques, or a short “pause” routine when feeling overwhelmed.
  • Maintain consistent mental‑health treatment – attend therapy sessions and take prescribed medications as directed.
  • Limit alcohol and recreational drugs – they can lower seizure threshold and exacerbate anxiety.
  • Stay physically active – exercise releases endorphins and stabilizes mood.
  • Develop a supportive network – friends, family, or support groups (e.g., PNES Foundation) provide validation and practical tips.
  • Regular medical review – yearly check‑ups to reassess neurological and psychiatric status.

Emergency Warning Signs

If any of the following occurs, call 911 or go to the nearest emergency department immediately:

  • Sudden loss of consciousness lasting more than a few minutes.
  • Difficulty breathing or choking during an episode.
  • Severe head injury or fall resulting in bleeding or persistent confusion.
  • First‑time seizure‑like event with a fever, rash, or recent infection.
  • Persistent vomiting, high fever (> 101 °F / 38.3 °C), or a new focal neurological deficit (e.g., weakness on one side).
  • Sudden, severe chest pain or palpitations that accompany the event.

References

  1. International League Against Epilepsy. “Position Paper on the Definition of PNES.” Epilepsia. 2022.
  2. World Health Organization. “Guidelines for EEG Monitoring in Seizure Disorders.” 2021.
  3. Reuber M, et al. “Cognitive‑behavioral therapy for psychogenic non‑epileptic seizures: A systematic review.” Neurology. 2020.
  4. Mayo Clinic. “Psychogenic non‑epileptic seizures (PNES).” Accessed May 2026.
  5. NIH National Institute of Neurological Disorders and Stroke. “Functional Neurological Disorder.” 2023.
``` *Word count: ~1,200 words.*

⚠️ Medical Disclaimer

Important: The information provided on this page is for general informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.

📚 Medical References