Unraveling PNES: A Window into the Brain-Body Connection

An overview of the Neuregen Approach for PNES and FND: Psychogenic non-epileptic seizures (PNES), also known as functional seizures, represent one of the most intriguing conditions at the intersection of neurology, psychiatry, and trauma recovery. Once dismissed as elusive or misunderstood, PNES is now recognized as a subtype of Functional Neurological Disorder (FND)—a rapidly evolving field that challenges traditional distinctions between “neurologic” and “psychiatric” disorders. At Neuregen Clinic in Scottsdale, Arizona, we are proud to be at the forefront of treating PNES and FND with a truly integrative approach that reflects the complexity of these conditions.

Above: Psychogenic Nonepileptic Seizures (PNES) are involuntary episodes resembling epileptic seizures but caused by psychological factors rather than neurological dysfunction. An integrative approach, combining neurological evaluation, psychological therapy, and education, is essential to address both the physical manifestations and underlying emotional triggers for effective management.

What Is PNES—and How Is It Different from Epilepsy?

PNES mimics epileptic seizures in appearance, with episodes that may involve convulsions, unresponsiveness, or dramatic motor movements. However, unlike epilepsy, PNES is not associated with abnormal electrical activity in the brain. Instead, it is believed to result from functional disruptions in the brain’s ability to process stress, emotion, and motor control—manifesting physically in the form of seizures (LaFrance et al., 2013).

Because PNES can look so similar to epilepsy, many patients go years without an accurate diagnosis. The gold standard for diagnosis is video-EEG monitoring, which captures the seizure event while simultaneously recording brain waves, showing no epileptic activity during the episode (Reuber & Rawlings, 2016).

PNES as Part of Functional Neurological Disorder (FND)

PNES is now recognized as a manifestation of FND, a condition where the nervous system stops working properly, even though no structural brain damage is present. FND can involve symptoms such as weakness, sensory changes, movement abnormalities, and non-epileptic seizures.

What makes FND and PNES especially fascinating is their embodiment of both neurologic and psychiatric features. Functional MRI studies have revealed altered connectivity in networks related to emotional regulation, motor control, and self-agency (Perez et al., 2018). For example, increased activity in the amygdala (a brain region involved in emotional processing) and disrupted communication between motor and emotional centers suggest that emotional stress can be misinterpreted by the brain and expressed as physical symptoms.

An Integrative Treatment Model: Why It Works

At Neuregen Clinic, we take an integrative approach to treating PNES and FND, which is particularly well-suited to these conditions. Our combination of psychiatric care, neurologic insight, and rehabilitative support helps patients address the multifaceted roots of their symptoms. Treatment often includes:

1. Psychotherapy—Especially CBT and Trauma-Informed Approaches

While Cognitive Behavioral Therapy (CBT) has the strongest evidence base for treating PNES, helping patients understand and manage the connection between thoughts, emotions, and physical symptoms (Goldstein et al., 2020), our approach to psychotherapy for PNES and FND, is to integrate multiple, modern psychotherapeutic approaches, including medical hypnotherapy, each aimed at particular components of the FND/PNES complex - this can be highly individualized. Additionally, therapies such as EMDR (Eye Movement Desensitization and Reprocessing) and somatic experiencing are often used when trauma is a contributing factor.

2. Physical and Occupational Therapy

Rehabilitative therapies are increasingly recommended for FND to help retrain movement, coordination, and body awareness. Even for seizure presentations, physical therapy can improve confidence and reduce symptom frequency by addressing the physical aftermath and nervous system dysregulation (Nielsen et al., 2021).

3. Neuromodulation and Innovative Interventions

At Neuregen, we offer ketamine therapy and stellate ganglion block (SGB), both of which are promising tools in the treatment of trauma-related dysregulation. SGB, in particular, has shown potential in resetting the autonomic nervous system, which is often on high alert in PNES patients due to chronic fight-or-flight activation. Ketamine, meanwhile, can catalyze psychological healing in treatment-resistant trauma and depression—common comorbidities in PNES (D'Andrea et al., 2021).

Hope for Healing: A Message to Patients

If you or someone you love has been diagnosed with PNES or FND, know this: the symptoms are real, and they are treatable. At Neuregen Clinic, our team understands the challenges and stigma that can accompany this diagnosis. More importantly, we are equipped with the knowledge and therapies to help guide you toward recovery.

The evolving science of PNES is a powerful reminder that the brain and body are deeply interconnected. When we bring together the best of psychiatry, neurology, and rehabilitative medicine, we not only treat symptoms—we help patients reclaim their lives.

References

D'Andrea, W., Benedetti, A., & Pole, N. (2021). Ketamine-assisted therapy for trauma-related disorders: A review of emerging research and clinical applications. Journal of Trauma & Dissociation, 22(2), 140–157. https://doi.org/10.1080/15299732.2021.1879766

Goldstein, L. H., Robinson, E. J., Mellers, J. D. C., Stone, J., Carson, A., & Reuber, M. (2020). Psychological treatments for adults with non-epileptic seizures: A systematic review and meta-analysis. Epilepsy & Behavior, 111, 107138. https://doi.org/10.1016/j.yebeh.2020.107138

LaFrance, W. C., Baker, G. A., Duncan, R., Goldstein, L. H., & Reuber, M. (2013). Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: A staged approach. Epilepsia, 54(11), 2005–2018. https://doi.org/10.1111/epi.12356

Nielsen, G., Ricciardi, L., Demartini, B., Hunter, R., Joyce, E., & Edwards, M. J. (2021). Outcomes of a specialist multidisciplinary treatment program for functional movement disorders. Journal of Neurology, Neurosurgery & Psychiatry, 92(2), 218–221. https://doi.org/10.1136/jnnp-2020-323889

Perez, D. L., LaFrance, W. C., & Barsky, A. J. (2018). The neuropsychiatry of functional neurological disorders: A perspective on the intersection of neurology and psychiatry. Psychosomatics, 59(6), 501–510. https://doi.org/10.1016/j.psym.2018.04.007

Reuber, M., & Rawlings, G. H. (2016). Nonepileptic seizures: Diagnosis and management. Handbook of Clinical Neurology, 139, 225–241. https://doi.org/10.1016/B978-0-12-801772-2.00019-3