Functional Neurological Symptoms / PNES

Understanding Functional Neurological Symptoms and PNES

Some patients experience real neurological symptoms even when routine scans or tests do not show structural damage. These symptoms may include weakness, numbness, tremor, blackouts, seizure-like episodes, walking difficulty, speech difficulty, dizziness, abnormal movements, or extreme fatigue.

Functional neurological disorder, or FND, refers to symptoms caused by a problem in nervous-system functioning rather than visible structural damage on routine tests. The symptoms are real. They are not fake, voluntary, or imagined.

PNES means psychogenic non-epileptic seizures. These are seizure-like episodes that are not caused by epileptic electrical discharges in the brain. They still require proper diagnosis, explanation, and treatment.

At JHN, we evaluate these symptoms carefully and respectfully. The goal is not to dismiss the patient. The goal is to understand the pattern, rule out important mimics, and guide the right treatment pathway.

Quick Check: Could This Be a Functional Neurological Symptom or PNES?

Patients may report:

• Seizure-like episodes
• Blackouts or spells
• Tremor or shaking episodes
• Weakness that varies over time
• Numbness or sensory symptoms
• Walking difficulty
• Imbalance
• Speech difficulty during episodes
• Sudden episodes triggered by stress, fatigue, pain, sleep loss, or emotional overload
• Symptoms that have been difficult to explain despite prior testing
• Conflicting opinions about epilepsy vs non-epileptic events
• Events that continue despite seizure medication

Key Point

Functional symptoms are real symptoms. FND and PNES are not “acting,” “drama,” or “attention-seeking.” They reflect a problem in how the nervous system is functioning, even if routine structural tests are normal.

What Can Mimic FND or PNES?

Before labeling symptoms as functional, important mimics must be considered.

These include:

• Epileptic seizures
• Syncope, meaning fainting
• Low sugar or metabolic problems
• Cardiac rhythm problems
• Migraine variants
• Stroke/TIA in acute settings
• Neuropathy or radiculopathy
• Movement disorders
• Medication or substance effects
• Sleep-related events
• Panic episodes
• Dissociative episodes
• Other medical or neurological conditions

Correct diagnosis matters because treatment differs.

What to Expect at Your First Visit

Your first visit focuses on listening carefully to the symptom story. We will ask what happens before, during, and after episodes; whether there are triggers; whether symptoms vary; what prior tests showed; what medicines have been tried; and how symptoms affect daily life.

If a family member has witnessed the event, their description is valuable. If a phone video is available, please bring it.

We may recommend EEG, video EEG, ECG, lab tests, NCV/EMG, sleep study, imaging referral, or psychology/psychiatry referral depending on the pattern.

When to Seek Medical Evaluation

You should seek evaluation if you have:

• Recurrent seizure-like episodes
• Blackouts or unexplained spells
• Weakness, numbness, tremor, or walking difficulty without a clear diagnosis
• Events despite seizure medication
• Conflicting opinions about epilepsy vs PNES
• Symptoms affecting work, school, relationships, or daily function
• Anxiety, trauma, stress, sleep disruption, or burnout alongside neurological symptoms
• Need for EEG or video EEG correlation
• Concern that prior explanations were unclear or dismissive

When to Seek Urgent Care

Seek urgent emergency care for:

• First seizure-like event
• Seizure-like event lasting more than 5 minutes
• Repeated events without recovery
• New weakness
• Facial droop
• Speech trouble
• Severe headache
• Head injury
• Fever or neck stiffness
• Severe confusion
• Chest pain
• Fainting with injury
• Any immediate safety concern

How JHN Evaluates FND / PNES

Evaluation may include:

• Detailed symptom and event history
• Witness description
• Phone video review when available
• Neurological examination
• Review of prior MRI, CT, EEG, blood tests, and prescriptions
• Screening for seizure features vs non-epileptic features
• Evaluation for fainting, sleep events, panic, migraine, movement symptoms, and metabolic contributors
• EEG or video EEG when clinically appropriate
• ECG when syncope or cardiac concerns are possible
• Lab testing for metabolic contributors when needed
• NCV/EMG if neuropathy, radiculopathy, or nerve involvement is suspected
• Sleep study / PSG if sleep-related events or sleep apnea are suspected
• Referral to psychology, psychiatry, physiotherapy, or neuro-rehabilitation when needed

Treatment Approach

Treatment depends on the diagnosis and may include:

• Clear explanation of the diagnosis and mechanism
• Safety planning for episodes
• Avoiding unnecessary escalation of anti-seizure medicines if events are confirmed non-epileptic
• Treating coexisting epilepsy if both conditions are present
• Sleep correction and fatigue management
• Stress, anxiety, trauma, or mood treatment when relevant
• Psychology or psychiatry support
• Physiotherapy or neuro-rehabilitation for movement, gait, or weakness symptoms
• Follow-up to track episode frequency, triggers, function, and safety

Some patients with PNES or FND also have other medical conditions. A functional diagnosis should not mean that future symptoms are ignored.

Patient-Friendly Summary

Unexplained neurological symptoms should be understood, not dismissed. FND and PNES are real conditions that require careful diagnosis, clear explanation, and coordinated care.

Connect with Our Healthcare Experts

Seizure-like episodes, blackouts, tremor, weakness, or unexplained neurological symptoms deserve respectful evaluation.
Book a functional neurological symptoms / PNES evaluation at Jain Healthcare Network, Sector 56, Gurugram.
WhatsApp/Call: 7836 001199.