People with functional neurological disorder (FND) have many different symptoms. Some have ongoing problems with movement or feeling, like weakness or numbness. Others have episodes that resemble epileptic seizures. These are called psychogenic non-epileptic seizures, or PNES.
However, with the more recent proposal to replace the name “PNES” with “functional seizures or functional/dissociative seizures” in order to more neatly fit these episodes under the umbrella of functional neurological disorders (and to obscure the distasteful “psychogenic” concept), there is an important risk. One that can create a new and significant obstacle in PNES patients’ pathway to care.
Can my PNES be treated by physical or occupational therapy?
Recently, I was alerted to this when several patients sent me inquiries in emails or asked questions when I was speaking at a webinar: Can physical therapy (PT) or occupational therapy (OT) be used to treat their PNES? They asked this because they heard that PT and OT can help treat FND motor and sensory symptoms. Therefore, logically, they thought, “If ‘functional seizures’ are a type of FND, then maybe it would make sense to get PT or OT.” They also reported that those therapies felt less stigmatizing than psychotherapy for mental health care which was another plus.
Although this thought process is understandable, it misses some important differences. PNES events are not continuous like functional motor or sensory symptoms might be; PNES occur irregularly. Also, PNES are brought on by emotional and physical dysregulation. This means that when patients experience but don’t “pick up on” intense emotional feelings, or body signals (of hunger, tiredness, thirst, etc.), their system gets out of balance and triggers a seizure-like episode. The only treatments with strong research support for PNES are specialized psychotherapies that directly target the seizures and the psychological factors that contribute to them (for example, depression, anxiety, or PTSD). Approaches such as cognitive behavioral therapy, mindfulness-based therapies, and prolonged exposure tailored for PNES, and psychoeducation and skills building modalities like PsychoEd for PNES, help patients recognize triggers, regulate emotions and bodily states, and reduce the frequency of events over weeks to months.
In contrast, PT and OT are most effective for continuous symptoms such as ongoing weakness, gait difficulties, or sensory changes. These therapies focus on retraining movement and daily functioning—skills that are not the primary issue in intermittent nonepileptic seizures. Moreover, addressing the underlying emotional and psychological drivers of PNES falls outside the scope of PT and OT.
Making sure patients understand how to reach the right treatments
The path to proper and effective care for PNES is already very confusing. Patients often see many doctors before getting a clear diagnosis. When messaging mixes all “functional” symptoms together, the path becomes even murkier. People may delay or avoid the tailored psychotherapies that research shows work. As a result, they may suffer with these seizures longer and the risk for chronicity also becomes greater.
As health professionals, we have a responsibility to provide accurate, unambiguous information that helps patients recover.
If the field continues to favor the broader term “functional seizures,” we must make a deliberate effort to clarify that these episodes are treated with evidence-based psychotherapies for PNES—not with physical or occupational therapy.