Functional seizures, previously known as Non-Epileptic Attack Disorder (NEAD), are a type of seizure that closely resembles Epilepsy but are not caused by abnormal electrical activity in the brain. Instead, they are the result of changes in how the brain functions, often linked to how the nervous system processes stress, psychological factors, or physical responses. While the seizures are very real and can be just as distressing or disabling as epileptic seizures, they arise from functional changes rather than structural damage or disease.

It’s also possible for someone to experience both epileptic and functional seizures, which is why an accurate, thorough diagnosis by a neurologist is essential.

What Causes Functional Seizures?

There is currently no known single cause of functional seizures. For some people, seizures begin after a traumatic event such as abuse, bereavement, a medical procedure, or an accident. For others, they may emerge after long-term stress or for no clear reason at all.

Many people feel confused by the diagnosis – particularly if they don’t feel overly anxious, and especially as seizures often occur during rest or sleep. This can lead to feelings of guilt or misunderstanding, but it’s important to know these seizures are not imagined, exaggerated, or under conscious control.

It’s Not Under Voluntary Control

Functional seizures are not something a person can control. Suggestions that they are being “put on” or are a “performance” are not only incorrect but deeply harmful.

During a seizure, the brain is responding to real internal signals, and the person cannot influence how their body behaves. After a seizure, people often feel exhausted or confused and need time to rest. Stressful environments – particularly when surrounded by strangers or faced with judgement – can worsen episodes or delay recovery.

Barriers in Everyday Life

Going out in public: Many people with functional seizures feel anxious or unsafe in public spaces. Fear of having a seizure in front of others, being misunderstood, or judged can lead to withdrawal and isolation.

Risk of injury: Functional seizures often involve sudden collapses or loss of awareness, which can lead to frequent injuries such as cuts, bruises, or even broken bones. This makes everyday activities more hazardous and unpredictable.

Accessing services: Some institutions and workplaces still fail to make reasonable adjustments, as required under the Equality Act 2010, further limiting independence and support.

Other Symptoms and Comorbidities

Functional seizures may occur alongside other FND symptoms – such as motor difficulties, sensory disturbances, or problems with speech and cognition.

In addition, FND is not a catch-all diagnosis. People may also have other medical conditions, which need to be carefully assessed and managed as part of the overall picture.

Diagnosis of Functional Seizures

A diagnosis should be made by a neurologist, ideally through clinical observation or video EEG, identifying positive features of functional seizures – not just by excluding Epilepsy.

A confident diagnosis is key. It should be explained clearly and respectfully to the patient, with care pathways and support offered promptly. Misdiagnosis and iatrogenic harm can be avoided when clinicians consider coexisting conditions and treat the person as a whole.

Treatment and Recovery

With the right support, people may see a significant reduction in seizure frequency and severity. Treatment approaches often include:

• Psychological therapy, such as CBT or trauma-informed support if appropriate.

• Grounding techniques and breathing exercises.

• Identifying potential triggers and working through responses to them.

At the heart of recovery is collaborative, compassionate care. FND Action advocate for support that is timely, accessible, and person-centred.

💡 Useful Resources

• 🟪 Seizure Medical Alert Card – from FND Action

• 📹 How to Video a Seizure – Guidance from FND Action

• 🚗 Driving rules – Epilepsy and Dissociative Seizures (GOV.UK)

• 🌻 Hidden Disabilities Lanyard – FND Action is part of the Sunflower Scheme. Available via our shop

🎥 Useful Videos