What differentiates a pseudo seizure from an epileptic seizure?

Reviewed by Yoshinori Abe, MD

Internal Medicine

Pseudo seizures, medically known as psychogenic non-epileptic seizures (PNES), are episodes that look like epileptic seizures but are not caused by abnormal electrical activity in the brain. Instead, they typically stem from psychological factors such as stress, trauma, or emotional distress. Because their symptoms closely mimic epilepsy, PNES are often misdiagnosed, making accurate identification essential for effective treatment.

If you or someone you know is experiencing seizure-like episodes, understanding the potential cause is the first step toward getting the right care. A free, instant, online symptom check can help you clarify what may be happening, identify possible conditions, and guide you on the best next steps—whether that means seeing a neurologist, a mental health professional, or another specialist. Taking a few minutes now could save you months of uncertainty.

Reviewed for medical accuracy: 07/20/2026

Important Next Steps

Learn if seizures need urgent care today Discover what’s causing seizure-like episodes See if it could be epilepsy Find OTC options for seizure symptoms Find a neurologist for seizure evaluation Discover medically valid home remedies for seizures Understand likely causes of your seizure-like spells

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Explanation

While both types of seizures may look similar, they have key differences in cause, diagnosis, and treatment:

Cause: Epileptic seizures result from sudden, abnormal electrical activity in the brain. Pseudo seizures (PNES) are often triggered by psychological stress or emotional conflict, not by brain electrical dysfunction.

Diagnosis: Epileptic seizures are detected through EEG (electroencephalogram), which shows abnormal brain activity. PNES usually show normal EEG patterns, even during an event. A video EEG (simultaneous brainwave recording and video monitoring) is often used for diagnosis.

Physical signs: PNES may include unusual movements like side-to-side head shaking, pelvic thrusting, or crying, which are uncommon in epileptic seizures. PNES events can last longer and may respond to distraction, unlike epileptic seizures.

Treatment: Epileptic seizures are treated with anti-seizure medications. PNES are typically managed through mental health therapy, such as cognitive behavioral therapy (CBT), rather than medication.

Both conditions are real and deserve proper evaluation and care. If you're experiencing seizure-like episodes or concerning symptoms, take Ubie's free AI-powered symptom checker to help identify what might be happening and determine the next steps for your health. A neurologist can help determine the type and best course of treatment.

(References)

McCutcheon IE. (2022). Seizures and pseudoseizures: The great divide. Progress in brain research, 35667799.
Herskovitz M. (2017). Stereotypy of psychogenic nonepileptic seizures. Epilepsy & behavior : E&B, 28427022.
Cardeña E, Pick S, & Litwin R. (2020). A mixed-methods, content analysis study. Epilepsy & behavior : E&B, 32388401.

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