FND Education Project

REFERENCE · RECOVERY

Recovery Techniques for Functional Seizures

Refers to:

For a fuller description of this symptom and the diagnostic techniques used to assess it, see Understanding & Diagnosis.

Convulsive or shaking events; still or unresponsive events; altered-awareness, sensory, autonomic or mixed seizure-like events; and inability to move when it forms part of the person’s assessed functional seizure. Scope boundary: Separate persistent or isolated limb movement loss belongs on the paralysis page. Sudden falls without definite blackout may need the drop-attacks pathway. A shared feature such as shaking does not identify the whole event. Epilepsy and functional seizures can coexist. [1]

Also described as: Dissociative seizures, functional/dissociative seizures, psychogenic nonepileptic seizures (PNES) and nonepileptic attacks. These are involuntary symptoms.

For the Person With FND
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For the Person With FND

Choose the help that fits the event

There is no cure for FND. Treatment and support can still be useful. Safety, access to activities, symptom relief and quality of life are legitimate goals whether or not seizures become less frequent. Continuing symptoms do not measure your effort or understanding.

Start with a clear diagnosis and an individual safety plan. Then select a small number of relevant options with your team; this is not a twelve-step programme that everybody must complete. Each link opens a standalone page with practical examples, supporter guidance, clinician procedures and its own sources.

About this list: 10 original entries map to 9 core pages after the two overlapping grounding entries were combined. One paediatric programme page and two care-planning pages bring the document total to 12. The collection index preserves the original groupings. A page count is not a count of independently validated treatments.

  1. Diagnostic Explanation and Continuing Care — Ask how the diagnosis was established for each event type and leave with a written explanation, a treatment contact and follow-up. [Clinical guideline recommendation; explanation alone is not an established seizure-stopping treatment]

  2. Individualized Episode Safety Plan — Prepare the surroundings and response for shaking, still or unresponsive events, especially when there is no time to act on a warning. [Clinical safety guidance; not a method for forcing an episode to stop]

  3. Warning and Pattern Mapping — Use a brief, low-burden record to find a usable early cue or recovery need; a trigger or remembered warning may never be identifiable. [Specialist clinical guidance; no requirement to find a trigger]

  4. Sensory Grounding and an Attention Anchor — At a familiar warning with enough awareness, try one tolerable visual or touch cue already practised in safety; skip cues that add sensory overload. [Specialist clinical guidance; individual grounding variants lack isolated efficacy evidence]

  5. Seizure-Focused Psychological Treatment — Choose a structured programme around the person’s goals, such as episode coping or returning to activities, with an honest discussion of mixed trial outcomes. [Research-supported programmes with mixed outcomes; individual components are not independently proven]

  6. Clinician-Taught Breathing Control — Seek respiratory assessment and comfortable, supervised practice when breathing patterns may be relevant; do not improvise breath-holding or deep-breathing drills. [Emerging evidence; a published randomized-trial protocol is not an efficacy result]

  7. Coexisting-Condition and Load Review — Address a specific untreated condition or practical burden, such as pain, sleep disruption or difficult access to care, even when seizures continue. [Clinical guideline and multidisciplinary care; benefits for another condition do not prove a seizure effect]

  8. Prescriber-Led Medication Review — Clarify the purpose of every regular and rescue medicine and arrange supervised changes only when indicated, including separate treatment for coexisting epilepsy. [Clinical guideline recommendation; no unsupervised withdrawal]

  9. Supported Return to Activities — Adapt one valued activity for event unpredictability, fatigue and safety, preserving the aids and help that make participation possible. [Clinical and occupational-therapy guidance; programme evidence does not establish a fixed activity dose]

Additional treatment-review and care pages

These pages add specialist detail or practical support; they are not extra entries in the original technique list.

  • Additional age-specific treatment page: ReACT for Children and Adolescents — Consider a clinician-delivered paediatric programme with an individualized response and family plan; its evidence does not establish the same approach for adults. [Emerging paediatric programme evidence; do not generalize directly to adults]

  • Additional supporter-planning guidance: Supporter Response Rehearsal — Talk through the agreed response with chosen supporters between events, including who stays, who helps and when medical escalation is needed. [Clinical guideline and safety guidance; rehearsal is an implementation aid]

  • Additional recovery-planning guidance: Recovery, Cluster and Flare Planning — Separate the visible event from prolonged recovery or surrounding symptoms and plan safe transfers, communication and reassessment for a changed pattern. [Individualized clinical care; distinguish familiar recovery from a new medical problem]

Familiar onset, no warning and the surrounding flare

When there is enough warning: get safe → reduce avoidable demands → use one rehearsed cue if suitable → follow the recovery plan. Do not keep trying strategies as awareness or safety deteriorates. When there is no usable warning, rely on the environment and supporter response. No one is at fault for an episode they could not interrupt. [1][6][7]

An episode, a cluster and the surrounding flare may have different time courses. Jerking, weakness, speech changes or fatigue can need separate support before or after the visible event. Do not assume that the end of shaking means you can immediately stand or swallow safely. See the recovery and cluster plan.

When usual self-management is not enough

Use your agreed emergency thresholds. A first event, serious injury, an event in water, abnormal breathing or a substantially changed pattern needs urgent assessment. Repeated events without usual recovery or prolonged reduced responsiveness need the medical response in your plan; without a clear plan, seek urgent advice. Do not assume every future event is functional. [1]

For the Person With FND
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For Family, Friends, and Other Supporters

Before, during and after

Agree the response while the person can choose, including sensory sensitivities, unwanted touch and what to do when there is no warning. Use one speaker where practical. Discussing symptoms may itself be difficult; planning can happen in short parts.

During an event, clear hazards, protect the head when feasible, stay nearby and observe breathing. Do not restrain, force limbs straight, put anything in the mouth or use pain. Do not give food, drink or oral medication during impaired awareness. Follow the individualized safety plan, including any separate epilepsy rescue instructions. If the person is unresponsive and not breathing normally, call emergency services and follow dispatcher instructions. [1][7]

Afterward, offer the agreed orientation and practical help without interrogation. Notice whether the person returns to their usual state between episodes. Do not push them to resume an activity before they can do so safely. The supporter rehearsal page explains how to prepare together.

For the Person With FND
For Family, Friends, and Other Supporters
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For Clinicians and the Care Team

Match the plan to the whole event

Document each event type, diagnostic certainty, semiology (its sequence and features), warning, awareness, duration, clustering and return to baseline. Record associated motor, speech and sensory symptoms separately when they have another time course. Consider coexisting epilepsy and other causes of new symptoms. Maintain a named route for follow-up. [1]

Select, rehearse and review

  1. Confirm diagnostic communication and a usable event-specific safety plan.
  2. Establish goals and access needs, including memory, sensory tolerance, fatigue and caregiver capacity.
  3. Choose warning-based work only when warning and task capacity are available; use environmental and supporter planning otherwise.
  4. Offer appropriate psychological intervention through shared decision-making and distinguish adult from paediatric evidence.
  5. Treat coexisting conditions and reconcile medicines by indication; never infer that all treatment is unnecessary because events are functional.
  6. Rehearse a low-burden strategy between events, without deliberately provoking symptoms, and define when to omit it.
  7. Review adverse effects, safety, participation and burden as well as event frequency. Adapt care when benefit is limited.

These are educational implementation examples, not a new standardized treatment protocol. Each detailed page explains its procedure and limits. Breathing requires suitable assessment; medication changes require the responsible prescriber; ReACT requires an appropriate clinician. [1][3][8]

Research distinctions that affect treatment choice

Adult seizure-focused CBT has mixed trial findings: the CODES primary 12-month seizure-frequency outcome was not statistically significant, while several secondary outcomes improved. Psychological programmes should not be represented as proof that each individual exercise works. ReACT has paediatric programme evidence with important design and generalization limits. [1][2][8][9]

Breathing control remains emerging. The 2024 pilot was small with substantial loss to follow-up; the 2026 scoping review does not establish a standalone effect. The BREATHS randomized-trial publication is a protocol, not efficacy results. [3][4][5]

For the Person With FND
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Research and Sources

General first-aid precautions are drawn from NHS guidance. Its emergency advice is adjacent safety guidance, not a functional-seizure treatment trial; an individualized event plan must address duration, uncertainty and coexisting epilepsy. [10]

Correction to the earlier grounding label

The earlier overview labelled sensory anchors as community-only. Sheffield and Neurosymptoms also describe grounding in specialist clinical guidance. The updated label reflects that clinical basis; an individual cool, textured or visual variant still lacks isolated efficacy evidence. Community accounts remain lived experience, not treatment trials. [6][7]

Neurosymptoms informs warning and grounding discussion, but this collection does not adopt its categorical injury/mortality reassurance, assumptions about awareness or interpretation of symptom changes as personal progress. Safety follows individual assessment, and symptom severity does not measure effort. See the editorial policy.

Citation Full citation and source
[1] Tolchin B, Goldstein LH, Reuber M, Stone J, Perez DL, LaFrance WC Jr, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. https://doi.org/10.1212/WNL.0000000000214466 FND-CIT-0010.
[2] Goldstein LH, Robinson EJ, Mellers JDC, et al.; CODES study group. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. The Lancet Psychiatry. 2020;7(6):491–505. https://doi.org/10.1016/S2215-0366(20)30128-0 FND-CIT-0033.
[3] Duncan R, Berlowitz DJ, Mullen S, et al. Breathing control training for functional seizures: a multi-site, open-label pilot study. Epilepsy & Behavior. 2024;154:109745. https://doi.org/10.1016/j.yebeh.2024.109745 FND-CIT-0034.
[4] Kanaan R, Duncan R, Mihalopoulos C, et al. Breathing control training as a treatment for functional seizures (BREATHS trial): a multicentre, assessor-blinded, randomised controlled efficacy and acceptability trial study protocol. BMJ Open. 2026;16(1):e107687. doi:10.1136/bmjopen-2025-107687 FND-CIT-0095.
[5] Zouki JJ, Ye H, Lo APK, et al. The therapeutic effect of breathing interventions for functional seizures: A scoping review. Epilepsy & Behavior. 2026;178:110919. doi:10.1016/j.yebeh.2026.110919 FND-CIT-0096.
[6] Sheffield Non-Epileptic Attacks clinical resource. What can I do to help myself get better? Specialist self-help guidance. Accessed September 14, 2026. FND-CIT-0097.
[7] Stone J. Treatment of Functional Seizures. Neurosymptoms. Specialist treatment overview. Accessed September 14, 2026. FND-CIT-0098.
[8] Fobian AD, Long DM, Szaflarski JP. Retraining and control therapy for pediatric psychogenic non-epileptic seizures. Annals of Clinical and Translational Neurology. 2020;7(8):1410–1419. doi:10.1002/acn3.51138 FND-CIT-0099.
[9] Watson C, Stager L, Valaiyapathi B, Goodin BR, Szaflarski JP, Fobian AD. Telehealth provision of Retraining and Control Therapy (ReACT) on cognitive and biopsychosocial functioning in pediatric functional neurological disorder. Journal of Psychosomatic Research. 2025;192:112112. doi:10.1016/j.jpsychores.2025.112112 FND-CIT-0100.
[10] NHS. What to do if someone has a seizure (fit). General seizure first aid. Reviewed December 19, 2023; accessed September 14, 2026. FND-CIT-0101.

Evidence checked and detailed collection added September 14, 2026 · Neurology, psychological, respiratory, occupational-therapy, paediatric, lived-experience, caregiver and accessibility review pending

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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