Functional seizures

Some functional seizures involve shaking, jerking or thrashing movements. To an onlooker, they can look very like a generalised epileptic seizure.

The movements may change from attack to attack, and some people stay partly aware during them.

Other functional seizures involve falling down and lying still, sometimes for many minutes, or staring spells where the person doesn’t respond.

These can be just as frightening for the person and the people around them.

Epileptic seizures come from sudden, abnormal electrical activity in the brain. Functional seizures come from a different brain process, linked to dissociation.

During a functional seizure, a test of brain electrical activity (EEG) usually shows normal signals.

Doctors look at how long the seizure lasts, how the head and limbs move, how long the person is unresponsive, what the eyes and mouth do, and whether there was a warning.

For example, eyes staying closed during a seizure with shaking is a common clue for a functional seizure. No single clue is enough on its own.

A person can have both functional seizures and epilepsy. Expert guidance asks doctors to check for co-occurring epilepsy, and to get a detailed description of each type of seizure.

Treatments designed for epilepsy don’t work for functional seizures. Instead, care focuses on learning skills to regain control, usually through talking therapy.

Specialists are right about 9 times in 10 when they can watch a video of an attack. When video-EEG isn’t possible, a smartphone video reviewed by an expert may be enough.

An EEG is most useful when it is combined with video of a typical attack. Doctors look for the pattern of a functional seizure, not just a “normal EEG”.

Brain scans like MRI don’t diagnose functional seizures, though they may be done to check for other conditions.

Expert guidance asks doctors to give a specific diagnosis and explain the reasons for it, with empathy. Family members or care partners can be included when the person wants that.

Being told your diagnosis with respect helps build trust and makes treatment more likely to work.

On average, people have waited about seven years for an accurate diagnosis, and many were first told they had epilepsy.

If that was your experience, your frustration makes sense. A clear diagnosis is the start of the right kind of help.

• Chest pain or a racing heart
• Dizziness or tingling
• Fear of losing control
• Feeling hot or cold, or sweating
• Feeling spaced out or unreal
• Shortness of breath

Warnings can last seconds or longer. Some people forget the warning afterwards. Warnings often get shorter over time if they aren’t worked on.

• Busy, noisy places or crowds
• Medical settings, like waiting rooms
• Places where it feels hard to leave
• Resting and not distracted, like on the sofa or in bed
• Surges of pain
• Thinking about upsetting memories

Often there is no clear trigger at all. Attacks are less likely when someone is absorbed in an activity.

Rapid, shallow breathing can worsen attacks. Many warning feelings overlap with panic, so techniques used for panic can help.

Worry about seizures can create a vicious circle: more worry, more seizures. Fears of injury, embarrassment, losing control or not being believed can all feed it.

Breaking this cycle is one of the main goals of treatment. It is not about blaming you for worrying. Anyone would worry.

• A new type of seizure
• A significant injury or fall
• Worries about their breathing

If you don’t know the person, don’t know their diagnosis, or are unsure in any way, call 911 (U.S.) or your local emergency number.

Bruises and minor bumps are common during functional seizures. Broken bones are rare, and serious injury is extremely rare.

Functional seizures are not dangerous to the brain in themselves.

Expert guidance asks doctors to talk with patients and their caregivers about a seizure action plan, plus driving and the effects on work and social life.

Cognitive behavioral therapy (CBT) made for functional seizures is usually the first treatment offered. It is often time-limited, around 12 to 15 sessions.

The 2026 American Academy of Neurology guideline found that psychological treatments may help reduce seizures, ease anxiety and improve quality of life.

Going to therapy doesn’t mean anyone thinks the seizures are “made up”. It is where people learn the practical skills that help.

Therapists help people notice their warning signs and respond early. Gently challenging alarming thoughts in the moment, like “I’m going to die” or “I’m going mad”, can help.

Understanding the blackout as the body’s response to frightening warning feelings can be a turning point for many people.

• Counting backwards in sevens or fours
• Playing a game on your phone
• Reading
• Singing
• Talking to someone

The task needs to be hard enough to really hold your attention.

Sensory grounding uses touch, sight, sound, smell or taste to keep you connected to the present when you start to feel spaced out. A technique like this was developed by specialists in Sheffield, UK, for dissociative seizures.

Slow breathing, muscle relaxation and calming imagery can also help.

Anxiety, depression, panic attacks and PTSD often come alongside functional seizures. Expert guidance asks doctors to check for these and for trauma, so they can be treated too.

Not everyone with functional seizures has trauma. If trauma is part of your story, it is not your fault. See the Healing from trauma guide.

Other approaches with some evidence include neurobehavioral therapy and motivational interviewing alongside therapy. Neurobehavioral therapy for adults uses weekly sessions, a workbook and practice at home.

Motivational interviewing has been shown to help people stick with treatment and improve quality of life.

Distress in the people around can make attacks worse. Staying calm and supportive helps the person feel safe.

Their seizures are real, even if tests are normal. Saying “I believe you” can mean a lot.

Ask the person, and their care team if they agree, what their seizures look like and what helps. Know when to call for help.

Once the seizure settles, encourage the person to get up when ready. Often they can carry on with what they were doing.

Treating a seizure as something that can pass, not a crisis, helps everyone feel more in control.

Watching someone you love have seizures can be exhausting and frightening. Your feelings matter too.

FND Hope is a registered U.S. charity led by and for people with FND, with branches in other countries. It offers information, support groups and advocacy. Website: fndhope.org.

The Functional Neurological Disorder Society brings together neurologists, psychiatrists, psychologists, therapists and others who work with FND. Its website has a referral directory and community resources. Website: fndsociety.org.

Neurosymptoms.org is a free patient guide to FND, including functional seizures, written by neurologist Prof Jon Stone. It is listed as a resource by NORD and by rehabilitation centers.

Support groups, in person or online, can help you feel less alone. FND Hope lists support groups on its website.

Remember that what others share is personal experience, not medical advice.